13 commercial payer policies list J9281. 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 13 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 J9281 |
|---|---|---|
| Mitomycin Gel (e.g., 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 J9281 |
|---|---|---|
| Oncology Medications |
| Jul 1, 2026 |
| Covered |
| Policy | Effective | Status of J9281 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9281 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9281 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9281 |
|---|---|---|
| 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 J9281 |
|---|---|---|
| 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 J9281 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9281 |
|---|---|---|
| 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 J9281 |
|---|---|---|
| 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 J9281 |
|---|---|---|
| Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List | Not recorded | Prior auth required |
| Policy | Effective | Status of J9281 |
|---|---|---|
| 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 J9281 |
|---|---|---|
| Jelmyto (mitomycin) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |