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See a sample rate comparisonHCPCS J9281 (Jelmyto) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Mitomycin pyelocalyceal instillation, 1 mg
| Key Fact | Detail |
|---|---|
| Service Type | Chemotherapy Drugs |
| Common Place of Service | 11 - Office None 24 - Ambulatory Surgical Center |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J9281 |
| Medicare Payment Limit | $318.531  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J9281 by major payers:
$302.50
$329.33
$333.09
$325.50
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HCPCS J9281
5 of 25 sample ratesHigher to lower in this preview
New York Presbyterian Hospital
$444.30Published rateRujuta Saksena
$342.50Published rateBernard Kulper
$328.48Published rateVenkat Subramaniam
$307.33Published rateMercer Bucks Hematology/Oncology PC, Bellevue Hematology/Oncology PC
$233.52Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J9281 vs. Other Chemotherapy Drugs Codes
The HCPCS J9281 code is part of the Chemotherapy Drugs services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J9281 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| J9280-HCPCS | Low | Injection, mitomycin, 5 mg |
| J9281-HCPCS | Moderate | Mitomycin pyelocalyceal instillation, 1 mg |
| J9285-HCPCS | Low | Injection, olaratumab, 10 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J9281. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J9281 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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