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

Current FDA label (SPL), effective Jun 8, 2026. This label includes a boxed warning.

Indications (excerpt from the label)

JYLAMVO is a folate analog metabolic inhibitor indicated for the: Treatment of adults and pediatric patients with acute lymphoblastic leukemia (ALL) as part of a combination chemotherapy maintenance regimen ( 1.1 ) Treatment of adults with mycosis fungoides ( 1.1 ) Treatment of adults with relapsed or refractory non-Hodgkin lymphoma as part of a metronomic combination regimen ( 1.1 ) Treatment of adults with rheumatoid arthritis ( 1.2 ) Treatment of pediatric patients with polyarticular juvenile idiopathic arthritis (pJIA) ( 1.3 ) Treatment of adults with severe psoriasis (1.4 ) 1.1 Neoplastic Disease JYLAMVO is indicated for the: treatment of adults and pediatric patients with acute lymphob…

Excerpt only. Read the full label for complete information.

Full label on DailyMed (opens in a new tab)