CommercialCoverageLow impact
State and School Employees' Health Insurance Plan - 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
New policy establishes that Encelto (revakinagene taroretcel-lwey), a gene therapy for idiopathic macular telangiectasia type 2 (MacTel), is not medically necessary for the State and School Employees' Health Insurance Plan. HCPCS code J3403 for this treatment is now listed as not covered, and related administration services will also be denied.
Action Required
Immediately: Billing team must update system to flag HCPCS J3403 as non-covered for Mississippi State and School Employee plan members. Ensure providers are aware that Encelto treatment and related administration services will be denied for these patients. Verify alternative covered treatments are available before scheduling MacTel procedures.