Effective January 1, 2021Permanent J code: J9281Download Billing and Coding Guide

Here to help patients get access to JELMYTO

With a dedicated team and end-to-end support, we're here to make the access, reimbursement, and coordination process as simple as possible for you and your patients.

Need help? Contact us.

1-855-JELMYTO (1-855-535-6986) Monday-Friday, 8 AM–8 PM ET

OUR COMPREHENSIVE SUITE OF SUPPORT OFFERINGS

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Conduct Benefits Investigations to confirm patient coverage details

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Determine patient affordability and financial assistance for eligible patients.

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Facilitate communications when prior authorization and coverage appeal process assistance are needed.

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Coordinate with you and the pharmacy on product acquisition, preparation, and delivery.

J9281

Offer billing and coding assistance — JELMYTO has pass-through status and a permanent J code.

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Provide a full support team of Territory Business Managers, Field Reimbursement Managers, and Clinical Nurse Educators.

*Additional restrictions and limitations may apply.

Overview of key steps

STEP
1

Provider enrolls patient in UroGen Support Program for JELMYTO

STEP
2

UroGen Support conducts benefits investigation, identifies potential prior authorization requirements, and determines eligibility for financial support options

STEP
4

JELMYTO is administered to the patient

STEP
3

UroGen Support and provider coordinate product acquisition, preparation, and delivery

STEP
4

JELMYTO is administered to the patient

Get started now

preview of patient enrollment form

Enrollment Form

This enrollment form must be completed and signed by the prescriber and patient and emailed or faxed to UroGen Support at Contact@UroGenSupport.com or 833-664-7216 in order for UroGen Support to provide assistance.

Download Coding & Billing Guide

Billing and Coding Guide

This resource includes necessary billing and coding information for JELMYTO processing and reimbursement.

Download Affordability Brochure

Affordability Brochure

UroGen Support is committed to helping patients get access to JELMYTO. This resource outlines the financial assistance programs that are available for eligible patients who have been prescribed JELMYTO. The appropriate program will depend on the patient's coverage.

Additional resources

preview of Scheduling and Ordering Resource

Scheduling and Ordering Resource

preview of declaration letter

Declaration Letter

PA and Appeals Checklist

PA and Appeals Checklist

Program Overview Brochure

Program Overview Brochure

preview of claim submission checklist

Claims Submission Checklist

Letter of Medical Necessity

Letter of Medical Necessity

Appeals Letter

Appeals Letter

JELMYTO Formulary Kit

JELMYTO Formulary Kit

JELMYTO J Code Brochure

JELMYTO J Code Brochure

JELMYTO Brand Story Leave Behind

JELMYTO Brand Story Leave Behind

JELMYTO Nephrostomy Instructions

JELMYTO Nephrostomy Instructions

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to UroGen Pharma at 1-855-987-6436.

Please click here for JELMYTO Full Prescribing Information, including the Patient Information, for additional information.

Please click here for Full Prescribing Information, Instructions for Pharmacy and Instructions for Administration.