HCPCS Level II › J codes J7315 Ophthalmic mitomycinMitomycin, ophthalmic, 0.2 mg
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 2 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 2 units per day (clinical), rationale: Prescribing Information Medicare pricing for J7315 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J7315 Payer coverage policies that name J7315 J7315 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Glaucoma Surgery (0484) covered if criteria are met Jul 14, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in IN, WA.
AZ: $430.00 (outpatient_hospital), effective Oct 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 MS: $430.00 (comprehensive), effective Jul 1, 2025 OH: $384.13 (provider_administered_drugs), effective Sep 1, 2013 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $361.87 (professional_administered_drugs), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.