Does J3403 require prior authorization?

No, J3403 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J3403?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J3403`, Revakinagene taroretcel-lwey, per implant

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Authorization will be issued for no more than one treatment per eye per lifetime and for no longer than 60 days from approval

Key Coverage Criteria

Encelto is proven and medically necessary for the treatment of adults with idiopathic MacTel who meet all of the following for initial therapy: patient age >= 18; diagnosis confirmed in at least one eye; monitored for retinal tears/detachment signs; prescribed by an ophthalmologist; dosing per FDA labeling; authorization for no more than one treatment per eye per lifetime and not longer than 60 days from approval.
Indication: Encelto is medically necessary for adults (age >= 18) with idiopathic MacTel type 2, requiring: (1) diagnosis confirmed in at least one eye, (2) ophthalmologist prescription, (3) dosing per FDA-approved labeling, (4) authorization for max 1 treatment per eye per lifetime and for up to 60 days from approval, and (5) monitoring for retinal tears/detachment.

Encelto is proven and medically necessary for the treatment of adults with idiopathic macular telangiectasia type 2 (MacTel) who meet all of the following: For initial therapy, all of the following: o Patient is at least 18 years of age; and o Submission of medical records (e.g., chart notes) confirming diagnosis of non-proliferative macular telangiectasia type 2 (MacTel) in at least one eye; and o Patient will be monitored for signs and symptoms of retinal tears and/or retinal detachment (e.g., [...]

3 Active Policies

UHC-POL-encelto, Encelto (Revakinagene Taroretcel-Lwey)

UMR-POL-UMR-encelto, Encelto (Revakinagene Taroretcel-Lwey)

SUREST-POL-SUREST-encelto, Encelto (Revakinagene Taroretcel-Lwey)

`J3403`, Revakinagene taroretcel-lwey, per implant

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

J3403, Revakinagene taroretcel-lwey, per implant

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`J3403`, Revakinagene taroretcel-lwey, per implant