`C9038` Inj mogamulizumab-kpkc

Injection, mogamulizumab-kpkc, 1 mg

Medicare coverage: Special coverage instructions apply
Status: terminated 20190930

Payer policies and prior authorization for C9038

2 of 3 payer prior-auth lists that name C9038 require prior authorization or set conditions: Molina Healthcare of Ohio.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01

Payer coverage policies that name C9038

C9038 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance (range C8957-C9235)	Mar 5, 2026	payer document

Medicaid fee-for-service

WY: $0.00 (professional), effective Jan 1, 2020

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.

C9038 Inj mogamulizumab-kpkc

Payer policies and prior authorization for C9038

Payer coverage policies that name C9038

Medicaid fee-for-service

`C9038` Inj mogamulizumab-kpkc