CommercialCoverageLow impact
Encelto (revakinagene taroretcel-lwey)
Blue Cross & Blue Shield of Mississippi·MS · Ophthalmology·Medical Policy
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
BCBS Mississippi has added a new policy stating that Encelto (revakinagene taroretcel-lwey), a gene therapy for macular telangiectasia type 2, is considered not medically necessary and will not be covered. Claims for this treatment and its administration will be denied unless approved through prior authorization review.
Action Required
Immediately: Billing team must flag HCPCS code J3403 (revakinagene taroretcel-lwey implant) as non-covered for BCBS Mississippi plans. Update billing system to require prior authorization for any Encelto treatments. Inform ophthalmologists that claims for this gene therapy and related administration services will be denied without PA approval.