MedicaidPrior AuthMedium impact
Prior Authorization Criteria for Denileukin Diftitox-cxdl (Lymphir) Effective April 1, 2026
Texas Medicaid·TX · Oncology, Hematology·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Apr 18, 2026
Summary
Effective April 1, 2026, prior authorization will be required for denileukin diftitox-cxdl (Lymphir) procedure code J9161 for Texas Medicaid patients. This drug treats relapsed or refractory cutaneous T-cell lymphoma in adults and requires specific CTCL diagnosis codes and clinical criteria to be met.
Action Required
Before April 1, 2026: Billing team must update system to require prior authorization for HCPCS code J9161 (denileukin diftitox-cxdl) for Texas Medicaid patients. Providers must use the Special Medical Prior Authorization (SMPA) Request Form and verify patients meet all clinical criteria including Stage I-III CTCL diagnosis, prior systemic therapy, and serum albumin >3 g/dL. Claims will be denied without proper prior authorization.