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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · OphthalmologyLow impact

Encelto (revakinagene taroretcel-lwey)

Act
immediately
Effective date
Oct 15, 2025
Identified
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.

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What to do

immediately · 3 steps
01Billing team must flag HCPCS code J3403 (revakinagene taroretcel-lwey implant) as non-covered for BCBS Mississippi plans.
02Update billing system to require prior authorization for any Encelto treatments.
03Inform ophthalmologists that claims for this gene therapy and related administration services will be denied without PA approval.

Codes mentioned

J3403

Original notice

Encelto (revakinagene taroretcel-lwey)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Encelto (revakinagene taroretcel-lwey)LowEffective Oct 15, 2025 · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesOphthalmologyCode J3403

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