MedicaidCoverageMedium impact
Additional Provider Types Added for Revakinagene Taroretcel-lwey (Encelto), Procedure Code J3403
Texas Medicaid·TX · Oncology, Hematology·Coding
Effective date
Feb 1, 2026
We identified it
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.
Action Required
Before February 1, 2026: Billing team must verify if practice operates free-standing, independent, or hospital ambulatory surgical centers that provide outpatient services. If applicable, update billing system to enable J3403 claims submission for revakinagene-taroretcel-lwey (Encelto) treatments. Contact TMHP at 800-925-9126 for specific billing requirements and ensure proper provider enrollment for this expanded coverage.