CSHCN 2008 > Physician > Benefits and Limitations

24.3.17.3 Clofarabine (Clorar)

Clofarabine (procedure code 1-J9027) is a benefit of the CSHCN Services Program.

Prior authorization of clofarabine injections is required.

Documentation of the following must be submitted with the prior authorization request:

•Refractory or relapsed acute lymphoblastic leukemia (diagnosis code 20400).

•At least two prior failed regimens.