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AetnaCommercial · Prior Auth · Medical Policy · Oncology, HematologyMedium impact

Denileukin Diftitox-cxdl (Lymphir) (CPB 1070, reviewed 2026-04-09)

Effective date
Nov 13, 2024
Identified
Aug 13, 2026

Summary

Aetna has established a new medical policy (CPB 1070, effective 11/13/2024) covering denileukin diftitox-cxdl (Lymphir) for cutaneous T-cell lymphoma (CTCL) stages I-III on commercial plans. All claims require precertification before treatment. Billing teams must implement prior authorization workflows and ensure proper coding using HCPCS code J9161 with associated administration codes.

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What to do

Action · 8 steps
01Before 11/13/2024 or immediately upon receipt.
02Billing team must update billing software to require precertification for HCPCS code J9161 (Lymphir injection) on all Aetna commercial plans.
03Providers must obtain precertification by calling (866) 752-7021 or faxing (888) 267-3277 before administering Lymphir for stage I-III CTCL (ICD-10: C84.A0-C84.A9, C84.AA, C86.30-C86.31).
04Add precertification requirement to the EMR/encounter form for oncology providers.
05Ensure infusion administration codes (96365-96368 or 96413-96417) are billed with J9161.
06For therapy continuation/reauthorization, verify no unacceptable toxicity or disease progression.
07All claims billed without precertification approval will be denied.
08Precertification forms available at Specialty Pharmacy Precertification portal.

Codes mentioned

963659636696367963689641396414964159641696417J9161C84.A0C84.A1C84.A2C84.A3C84.A4C84.A5C84.A6C84.A7C84.A8C84.A9C84.AAC86.30C86.31

Original notice

Denileukin Diftitox-cxdl (Lymphir) (CPB 1070, reviewed 2026-04-09)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOncologyHematologyCode 96365Code 96366Code 96367Code 96368Code 96413Code 96414Code 96415Code 96416Code 96417Code J9161Code C84.A0Code C84.A1Code C84.A2Code C84.A3Code C84.A4Code C84.A5Code C84.A6Code C84.A7Code C84.A8Code C84.A9Code C84.AACode C86.30Code C86.31

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