J9281 HCPCS code: Mitomycin pyelocalyceal instillation, 1 mg
J9281 is the HCPCS Level II code for mitomycin pyelocalyceal instillation, 1 mg. In 2024 Medicare paid an average of $226.83 per service for J9281 across 72,795 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 80 per day on outpatient hospital claims. Medicare volume rose 45% from 2022 to 2024 (50,128 to 72,795 services). In 2024, about 186 clinicians billed Medicare for J9281 for 211 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2021-01-01 |
| Last action effective | 2021-01-01 |
Who bills J9281 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 186 |
| Medicare beneficiaries | 211 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9281, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 50,128 | 160 | $269.19 | $214.76 |
| 2023 | 73,047 | 201 | $286.33 | $228.13 |
| 2024 | 72,795 | 211 | $284.70 | $226.83 |
States with the most J9281 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 6,799 | $237.80 |
| Massachusetts | 5,360 | $237.82 |
| Georgia | 4,521 | $238.88 |
| South Carolina | 3,160 | $86.10 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 80 | CMS Policy |
| practitioner claims | 80 | CMS Policy |
What changed for J9281
- 2021-01-01: J9281 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J9281?
J9281 is the HCPCS Level II code for mitomycin pyelocalyceal instillation, 1 mg. Short descriptor: "Mitomycin instillation".
How much does Medicare pay for J9281?
In 2024, the average Medicare payment was $226.83 per service (average allowed $284.70).
Does Medicare cover J9281?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9281 can be billed per day?
80 on outpatient hospital claims; 80 on practitioner claims (NCCI medically unlikely edits).
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Next steps
- Run a reimbursement report for a device billed under J9281
- Watch J9281 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9281
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.