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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Ophthalmology, PharmacyLow impact

MA08.013, Revakinagene taroretcel-lwey (Encelto®)

Effective date
Dec 29, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross Medicare Advantage has reissued MA08.013 with no substantive changes, reaffirming coverage for Encelto® (revakinagene taroretcel-lwey) for adults with idiopathic macular telangiectasia type 2 (MacTel) when specific medical necessity criteria are met. The policy became effective 12/29/2025 and was reviewed again on 09/30/2026 with the same coverage position maintained.

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What to do

Action · 4 steps
01By 12/29/2025: Billing and clinical teams should ensure familiarity with coverage criteria for HCPCS code J3403 (Encelto® implant).
02Update any prior authorization workflows or internal documentation templates to reflect the specific medical necessity requirements: documented MacTel Type 2 diagnosis via imaging, BCVA of 54-letter ETDRS or 20/80 Snellen or better, and absence of contraindications (infections, hypersensitivity to Endo-SFM, glaucoma, severe diabetic retinopathy, uveitis, intraretinal hyperreflectivity, neovascularization, recent eye surgeries/procedures, or prior Encelto implant in same eye).
03Providers performing intravitreal implantation must document all required clinical findings.
04Since this is a reissue with no changes, no immediate billing system modifications are required unless this is the first time your practice is implementing this policy.

Codes mentioned

J3403H35.071H35.072H35.073

Original notice

MA08.013, Revakinagene taroretcel-lwey (Encelto®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.02.44, Revakinagene taroretcel-lwey (Encelto®)MediumEffective Dec 29, 2025 · Pharmacy08.02.44, Revakinagene taroretcel-lwey (Encelto®)MediumEffective Dec 29, 2025 · PharmacyMA08.013, Revakinagene taroretcel-lwey (Encelto®)MediumEffective Dec 29, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOphthalmologyPharmacyCode J3403Code H35.071Code H35.072Code H35.073

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