Jonathan Rubenstein, MD, outlines billing strategy for emerging NMIBC treatments

In this video, Jonathan Rubenstein, MD, a urologist with Chesapeake Urology in Towson, Maryland, discusses the billing and operational implications of a forthcoming J code for the gemcitabine intravesical system (Inlexzo) (the code, J9183, will be available starting April 1, 2026) and shares best practices for practices preparing to adopt new therapies in the non–muscle invasive bladder cancer (NMIBC) treatment landscape.

Rubenstein explained that the product is currently billed using an unlisted code, which requires direct communication with insurers to confirm reimbursement. Because the therapy is an expensive intravesical device that must be placed in the bladder and periodically exchanged, reimbursement certainty is critical for practices. The establishment of a dedicated J code will provide greater transparency about reimbursement rates and contractual coverage, giving clinicians and administrators more confidence in adopting the therapy.

However, Rubenstein cautions that practices should not rely on early reports of a J code number before it becomes officially active. Providers should confirm the activation date and billing eligibility before using the code. If a prior authorization was initially obtained using an unlisted code before the J code becomes active, he recommends submitting a new prior authorization once the J code is active. This step helps ensure appropriate reimbursement for a high-cost therapy and reduces financial risk to the practice.

As additional treatments enter the space for BCG‑unresponsive NMIBC, Rubenstein emphasizes the importance of strong clinical documentation and preparation by billing teams. Practices should clearly understand each therapy’s labeled indication, including whether it applies to specific disease features such as carcinoma in situ, tumor grade, or disease stage. Insurance companies frequently require detailed confirmation that a patient meets the precise criteria for the therapy being prescribed.

For urologists and clinical teams, documenting tumor grade, stage, and relevant disease characteristics in the patient chart is essential. Billing and prior authorization staff rely on this information to secure approval and reimbursement. Although detailed documentation requires additional effort, Rubenstein notes that missing even a single reimbursement cycle for these costly medications can have significant financial consequences for a practice.