Mitomycin instillation
Products billed under this code include Jelmyto.
Payment limit per 1 MG, by effective quarter, 1Q21 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under this code include Jelmyto.
Payment limit per 1 MG, by effective quarter, 1Q21 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Jelmyto | UroGen Pharma | 72493-0103-03 | 80 | $26,325.68 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $329.071 | −$0.866 | 1 MG | Mitomycin instillation | v1, posted September 17, 2026 |
| 3Q26 | $329.937 | +$6.766 | 1 MG | Mitomycin instillation | v1, posted September 15, 2026 |
| 2Q26 | $323.171 | −$0.734 | 1 MG | Mitomycin instillation | v1, posted September 15, 2026 |
| 1Q26 | $323.905 | +$5.374 | 1 MG | Mitomycin instillation | v1, posted September 15, 2026 |
| 4Q25 | $318.531 | +$1.11 | 1 MG | Mitomycin instillation | v1, posted September 8, 2026 |
| 3Q25 | $317.421 | +$4.426 | 1 MG | Mitomycin instillation | v1, posted March 10, 2026 |
| 2Q25 | $312.995 | +$1.639 | 1 MG | Mitomycin instillation | v1, posted March 10, 2026 |
| 1Q25 | $311.356 | +$4.014 | 1 MG | Mitomycin instillation | v1, posted December 19, 2025 |
| 4Q24 | $307.342 | +$0.683 | 1 MG | Mitomycin instillation | v1, posted June 11, 2025 |
| 3Q24 | $306.659 | +$6.068 | 1 MG | Mitomycin instillation | v1, posted June 11, 2025 |
| 2Q24 | $300.591 | −$0.156 | 1 MG | Mitomycin instillation | v1, posted March 11, 2025 |
| 1Q24 | $300.747 | +$6.381 | 1 MG | Mitomycin instillation | v1, posted December 19, 2024 |
| 4Q23 | $294.366 | −$1.807 | 1 MG | Mitomycin instillation | v1, posted October 10, 2024 |
| 3Q23 | $296.173 | +$6.663 | 1 MG | Mitomycin instillation | v1, posted June 5, 2024 |
| 2Q23 | $289.51 | −$0.792 | 1 MG | Mitomycin instillation | v1, posted February 23, 2024 |
| 1Q23 | $290.302 | +$5.198 | 1 MG | Mitomycin instillation | v1, posted December 6, 2023 |
| 4Q22 | $285.104 | −$0.257 | 1 MG | Mitomycin instillation | v1, posted June 22, 2023 |
| 3Q22 | $285.361 | +$4.144 | 1 MG | Mitomycin instillation | v1, posted June 9, 2023 |
| 2Q22 | $281.217 | −$0.573 | 1 MG | Mitomycin instillation | v1, posted December 14, 2022 |
| 1Q22 | $281.79 | −$0.089 | 1 MG | Mitomycin instillation | v1, posted June 8, 2022 |
| 4Q21 | $281.879 | −$0.244 | 1 MG | Mitomycin instillation | v1, posted June 2, 2022 |
| 3Q21 | $282.123 | −$0.109 | 1 MG | Mitomycin instillation | v1, posted June 2, 2022 |
| 2Q21 | $282.232 | +$0.06 | 1 MG | Mitomycin instillation | v1, posted March 1, 2022 |
| 1Q21 | $282.172 | – | 1 MG | Mitomycin instillation | v1, posted December 10, 2021 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.