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

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Effective for dates of service on or after February 1, 2026, the Texas Medicaid & Healthcare Partnership (TMHP) will consider claims for revakinagene-taroretcel-iwey (Encelto) (procedure code J3403) for reimbursement when providers at free-standing, independent, or hospital ambulatory surgical centers render services in the outpatient hospital setting.

For more information, call the TMHP Contact Center at 800-925-9126.

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.