C9028 Inj. inotuzumab ozogamicin

Injection, inotuzumab ozogamicin, 0.1 mg

Payer policies and prior authorization for C9028

Payer coverage policies that name C9028

C9028 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range C8957-C9235)Mar 5, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in WA.

  • WY: $0.00 (professional), effective Jan 1, 2019

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.