New Provider Types Approved for Revakinagene Taroretcel-lwey (Encelto), Procedure Code J3403
The Texas Medicaid & Healthcare Partnership (TMHP) has expanded the provider types eligible for reimbursement related to revakinagene taroretcel-lwey (Encelto) under procedure code J3403. This update was last revised on January 16, 2026.
Starting February 01, 2026, TMHP will begin considering claims for Encelto (J3403) when the service is provided by approved providers working through:
- Free-standing ambulatory surgical centers (ASCs)
- Independent ASCs
- Hospital-based ambulatory surgical centers
This applies when services are delivered in an outpatient hospital setting.
Important note for managed care claims: Texas Medicaid managed care organizations (MCOs) are required to provide all medically necessary Medicaid-covered services for enrolled members. However, administrative requirements such as prior authorization, precertification, referrals, and claims submission procedures may vary compared to traditional fee-for-service Medicaid and may differ by MCO. The providers are advised to call the particular MCO of the member to get plan-specific requirements and instructions.
Providers may call the TMHP Contact Center at 800-925-9126 with questions or support.
