Diagnosis Codes
Malignant neoplasm of unspecified renal pelvis
What is C65.9
Total billable units for J9281
80mg
This form is used to establish or set up Cardinal accounts for Jelmyto Ordering
Declaration Letter
Patient enrollment forms are sent here
UroGen Support
Malignant neoplasm of right unspecified renal pelvis
C65.1
This modifier is used to indicate wastage
JW
The fee associated with mixing services
$300
This type of authorization is needed before a benefits investigation can be initiated by UroGen Support
Patient Authorization
Malignant neoplasm of left unspecified renal pelvis
C65.2
The WAC pricing for J9281
$21,376.00
Questions related to Dec Letters and account status should be referred directly to this organization or phone number
Cardinal Health at 877-488-3572
Malignant neoplasm of right ureter
C66.1
The 340B price for J9281
$16,438.14
Current "best" terms for Cardinal invoicing
120 day (dependent on credit)
This series of diagnosis codes starting with C66 has recently been added to the Patient Enrollment Form
Malignant neoplasm of the ureter
Malignant neoplasm of left ureter
C66.2
2021 Q4 Medicare FFS published reimbursement Rate
$281.879/mg
Newest "best" terms for Cardinal invoicing
60 days (dependent on credit)
The phone number patients can call in to give verbal authorization
1-855-Jelmyto