2025 HCPCS code J7315
(Active) Effective Date: N/A Drugs Administered Other than Oral Method - Miscellaneous Drugs Feed
Mitomycin, ophthalmic, 0.2 mg
The medical necessity for J7315 is established by the diagnosis of glaucoma requiring surgical intervention (trabeculectomy) and the use of mitomycin to prevent post-surgical complications such as scarring.
The ophthalmologist applies this antimetabolite topically to the eye during glaucoma filtration surgery.
In simple words: J7315 is a code for a drug called mitomycin, used in eye surgery to prevent scarring. It's applied to the surface of the eye during glaucoma surgery.
This code represents the supply of mitomycin, an ophthalmic drug, in a 0.2 mg dosage. It's used topically during glaucoma filtration surgery (trabeculectomy) to inhibit scar formation. Mitosol is a brand name for this drug supplied in individual vials containing 0.2 mg of lyophilized (dry) mitomycin. 1 ml of sterile water is added to reconstitute the drug to the proper concentration. In dry form, Mitosol is storable for up to two years; once reconstituted, it must be used within one hour.
Example 1: A patient undergoes a trabeculectomy for glaucoma. The ophthalmologist applies Mitosol (mitomycin) topically to the surgical site to prevent scarring and promote successful filtration., During a glaucoma surgery, the surgeon uses one vial of J7315 which represents 0.2mg of Mitosol., A patient with glaucoma requires a trabeculectomy and mitomycin is utilized to inhibit excessive scar tissue formation during the healing process. The surgeon uses a 0.2 mg dose of mitomycin opthalmic.
Documentation should include the diagnosis of glaucoma, the use of mitomycin during the trabeculectomy, the dosage administered (0.2 mg), and the NDC for Mitosol (49771-002-01).
** The National Drug Code (NDC) for Mitosol (0.2 mg) is 49771-002-01. As of Q1 2015, the Medicare allowed amount per vial was $372.80. Mitosol had "orphan drug" status when used in pterygium surgery.
- RVU: Medicare reimbursement is based on the manufacturer's average selling price (ASP) and is revised quarterly. Pass-through payments are not subject to the 20% Medicare copayment.
- Specialties:Ophthalmology, specifically glaucoma specialists.
- Place of Service:Ambulatory Surgical Center, Physician Office, Hospital Outpatient Department