13 commercial payer policies list J9280. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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13 policies from 9 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J9280 |
|---|---|---|
| Glaucoma Surgery | Mar 24, 2023 | Covered |
| Hypertrophic Scars and Keloids | Jun 22, 2023 | Covered |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Mitomycin Gel (e.g., Jelmyto) | Not recorded | Covered with conditionsInferred from policy title |
| Mitomycin Intravesical Solution (e.g., Zusduri) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J9280 |
|---|---|---|
| Mitomycin (Zusduri) | Dec 2, 2025 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Mitomycin Gel(Jelmyto) | Jun 30, 2020 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Jelmyto (mitomycin) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Zusduri (mitomycin) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Mitomycin for Pyelocalyceal Solution (Jelmyto) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Mitomycin Instillation Solution (Jelmyto, Zusduri); CP.PHAR.495 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9280 |
|---|---|---|
| Mitomycin for Pyelocalyceal Solution (Jelmyto) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |