← Back to list
State and School Employees' Health Insurance Plan - Encelto (revakinagene taroretcel-lwey)
Act
immediately
Effective date
Oct 15, 2025
Identified
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.
Get alerts when payers change rules like this one
We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.
What to do
immediately · 3 steps
01Billing team must update system to flag HCPCS J3403 as non-covered for Mississippi State and School Employee plan members.
02Ensure providers are aware that Encelto treatment and related administration services will be denied for these patients.
03Verify alternative covered treatments are available before scheduling MacTel procedures.
Codes mentioned
J3403
Original notice
State and School Employees' Health Insurance Plan - Encelto (revakinagene taroretcel-lwey)
bcbsms.com · Always check the source before changing claims.