C9174 Datopotamab deruxtecan, 1 mgInjection, datopotamab deruxtecan-dlnk, 1 mg
0 of 1 payer prior-auth lists that name C9174 require prior authorization or set conditions.
C9174 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Injectable Medications (0020) | listed, no stance (range C8957-C9235) | Mar 5, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Injectable Oncology (S.5.01.561) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Injectable Oncology (L.5.01.561) | listed, no stance | payer document | |
| Premera Blue Cross | Antibody-Drug Conjugates (5.01.582) | listed, no stance | Aug 11, 2026 | payer document |
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.