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Texas MedicaidMedicaid · Coverage · Coding · TX · Oncology, HematologyMedium impact

Additional Provider Types Added for Revakinagene Taroretcel-lwey (Encelto), Procedure Code J3403

Effective date
Feb 1, 2026
Identified
Jan 17, 2026

Summary

Effective February 1, 2026, Texas Medicaid will expand coverage for revakinagene-taroretcel-lwey (Encelto) procedure code J3403 to include additional provider types: free-standing, independent, and hospital ambulatory surgical centers in outpatient hospital settings. This expands who can bill for this specialized drug treatment.

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What to do

Action · 3 steps
01Before February 1, 2026: Billing team must verify if practice operates free-standing, independent, or hospital ambulatory surgical centers that provide outpatient services.
02If applicable, update billing system to enable J3403 claims submission for revakinagene-taroretcel-lwey (Encelto) treatments.
03Contact TMHP at 800-925-9126 for specific billing requirements and ensure proper provider enrollment for this expanded coverage.

Codes mentioned

J3403

Original notice

Additional Provider Types Added for Revakinagene Taroretcel-lwey (Encelto), Procedure Code J3403
tmhp.com · Always check the source before changing claims.
View original ↗

Related policy hubs

Texas Medicaid policiesTX policy changesOncologyHematologyCode J3403

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