Jylamvo (methotrexate) NDC 81927-204

NDC codes

FDA NDC Directory

Product NDC (as listed)81927-204Labeler and product segments. Claims need a package NDC.

Product NDC at billing width81927-0204Add the package segment from the table below.

Package NDCs as listed with the FDA, and the 11-digit 5-4-2 form used on claims. The highlighted digit is the added leading zero.
Package NDC	11-digit (billing)	Package	Copy
81927-204-01	81927020401	1 BOTTLE, GLASS in 1 CARTON (81927-204-01) / 60 mL in 1 BOTTLE, GLASSMarketed from Dec 15, 2023

How the 11-digit form is made: The product segment has 3 digits, so one leading zero is added to it (5-3-2 → 5-4-2). Formatting the NDC does not by itself make it billable — the product, package and quantity must match what was dispensed or administered, and payer rules apply. Conversion rules

Product information

Brand name (proprietary): Jylamvo
Generic name (nonproprietary): methotrexate
Active ingredients: Methotrexate — 2 mg/mL
Dosage form: Solution
Route: Oral
Labeler: SHORLA ONCOLOGY INC.
Product type: Prescription drug
Marketing category: NDA — New Drug ApplicationApplication NDA 212479
Marketing start: Dec 15, 2023
Listing expires: Dec 31, 2027
Other FDA classes: Folic Acid Metabolism Inhibitors (Mechanism)
Identifiers: Product ID 81927-204_53bd9776-70ec-46f9-e063-6294a90a7011SPL ID 53bd9776-70ec-46f9-e063-6294a90a7011SPL set ID 96e931f5-51ae-4bdf-a441-bb0dd26d4c0eRxCUI 2671456, 2671462UNII YL5FZ2Y5U1UPC 0381927204017
Pharmacologic class: Folate Analog Metabolic Inhibitor

Billing references

What Med-Code can say about coding this product, and where each statement comes from. Nothing here is inferred from the name alone.

HCPCS codeNo match

No HCPCS code in Med-Code's directory. Oral products like this are usually dispensed by a pharmacy and billed by NDC.

NDC on a medical claim

N481927020401 followed by a unit qualifier and the quantity

Package 81927-0204-01. Unit qualifiers: F2 (international unit), GR (gram), ME (milligram), ML (milliliter), UN (unit (each)). The qualifier and quantity depend on what was given. About the N4 qualifier

Product label

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