H35.071 Insurance Policy Changes

ICD-10 H35.071 is officially defined as "Retinal telangiectasis, right eye." code H35.071 is referenced in 5 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code H35.071 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Dec 29, 2025Medium impact
08.02.44, Revakinagene taroretcel-lwey (Encelto®)
Independence Blue Cross has reissued Policy 08.02.44 establishing coverage criteria for revakinagene taroretcel-lwey (Encelto®), a newly FDA-approved gene therapy for adults with idiopathic macular telangiectasia type 2 (MacTel). The policy defines strict medical necessity requirements including documented diagnosis via imaging, visual acuity thresholds, exclusionary conditions, and prior surgical history limitations. All other uses remain experimental/investigational and not covered.
Independence Blue Cross · Effective Dec 29, 2025Medium impact
08.02.44, Revakinagene taroretcel-lwey (Encelto®)
Independence Blue Cross reissued Policy 08.02.44 on 12/29/2025 with no substantive changes to coverage criteria for Encelto® (revakinagene taroretcel-lwey), a newly FDA-approved gene therapy for idiopathic macular telangiectasia type 2 (MacTel). The policy establishes medical necessity requirements, documentation standards, and coverage limitations for this high-cost ophthalmologic implant procedure.
Aetna · Effective Jul 16, 2025Medium impact
Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-10-05)
Aetna considers one intravitreal implant of Encelto (revakinagene taroretcel-lwey) per affected eye medically necessary for adults with idiopathic macular telangiectasia type 2 (MacTel) when the listed criteria are met, and considers all other indications experimental, investigational or unproven. The policy covers commercial medical plans, requires precertification in applicable plan designs, and requires that the drug be prescribed by or in consultation with an ophthalmologist. Members with intraretinal or subretinal neovascularization, anti-VEGF therapy within the past 3 months, glaucoma, uveitis, or current chemotherapy are listed as not eligible for the implant.
Aetna · Effective Jul 16, 2025Medium impact
Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-07-17)
Aetna considers one intravitreal implant of revakinagene taroretcel-lwey (Encelto) medically necessary per affected eye for adults with idiopathic macular telangiectasia type 2 (MacTel) when all the listed criteria are met, and considers all other indications experimental, investigational or unproven. Eligibility requires fluorescein leakage in at least one eye with one of the listed features, a photoreceptor inner segment/outer segment break in the ellipsoid zone of 0.16 mm2 to 2.00 mm2 on spectral domain OCT, and best corrected visual acuity of 54 letters or better (20/80 or better) on the ETDRS chart. Exclusions include neovascular MacTel, prior intravitreal anti-VEGF therapy in the affected eye or in the non-affected eye within the past 3 months, glaucoma, uveitis, and inability to temporarily discontinue antithrombotic therapy. The implant must be prescribed by or in consultation with an ophthalmologist, and it requires precertification.
Independence Blue Cross · Effective Dec 29, 2025Low impact
MA08.013, Revakinagene taroretcel-lwey (Encelto®)
Independence Blue Cross Medicare Advantage has reissued MA08.013 with no substantive changes, reaffirming coverage for Encelto® (revakinagene taroretcel-lwey) for adults with idiopathic macular telangiectasia type 2 (MacTel) when specific medical necessity criteria are met. The policy became effective 12/29/2025 and was reviewed again on 09/30/2026 with the same coverage position maintained.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code H35.071?

There are 5 tracked policy changes affecting code H35.071, including updates from Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code H35.071?

Payers that have issued tracked updates for code H35.071 include: Independence Blue Cross, Aetna.

How do I get notified when code H35.071 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code H35.071. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code H35.071?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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08.02.44, Revakinagene taroretcel-lwey (Encelto®)

08.02.44, Revakinagene taroretcel-lwey (Encelto®)

Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-10-05)

Revakinagene Taroretcel-lwey (Encelto) (CPB 1079, reviewed 2026-07-17)

MA08.013, Revakinagene taroretcel-lwey (Encelto®)

What insurance policy changes affect code H35.071?

Which payers have updated policy for code H35.071?

How do I get notified when code H35.071 policy changes?

Why do payers change policies for code H35.071?