Benefit and Prior Authorization Criteria for Kebilidi

Date: August 3, 2026

Attention: All Providers

Effective date: July 1, 2026

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective for dates of service on or after July 1, 2026, eladocagene exuparvovec-tneq (Kebilidi) is a benefit of Texas Medicaid when it is submitted on a claim with procedure code J3590. Prior authorization will be required beginning September 1, 2026.

Eladocagene exuparvovec-tneq (Kebilidi) (procedure code J3590) is an adeno-associated virus (AAV) vector-based gene therapy indicated to treat adult and pediatric patients with aromatic L-amino acid decarboxylase (AADC) deficiency.

Eladocagene exuparvovec-tneq (Kebilidi) is limited to one infusion per lifetime.

Prior Authorization Requirements

Providers must submit prior authorization requests for eladocagene exuparvovec-tneq (Kebilidi) on a Special Medical Prior Authorization (SMPA) Request Form.

The Texas Medicaid & Healthcare Partnership (TMHP) may approve prior authorization for eladocagene exuparvovec-tneq (Kebilidi) single-dose intraputaminal infusion for patients who meet the following requirements:

• The patient is 16 months of age or older.
• The patient has a confirmed diagnosis of AADC deficiency (diagnosis code E7081).
• The patient has biallelic mutations in the dopa decarboxylase (DDC) gene.
• There is documentation of skull assessment confirming that the patient has achieved skull maturity by neuroimaging, which is necessary for stereotactic neurosurgical administration of eladocageneexuparvovec-tneq (Kebilidi) therapy.
• The patient has not previously received eladocageneexuparvovec-tneq (Kebilidi) infusion for AADC deficiency.

Required Monitoring Parameters

After eladocageneexuparvovec-tneq (Kebilidi) infusion, providers must monitor the patient for the following:

• Post-procedural complications, which may include events of respiratory and cardiac arrest after administration
• Additional procedure-related adverse events, such as cerebrospinal fluid leak, intracranial bleeding, neuroinflammation, acute infarction, and infection
• Signs of dyskinesia or involuntary movements of the face, arm, leg, or entire body (fidgeting, writhing, wriggling, head bobbing, or body swaying) after administration

Next step for providers: Providers should share this information with their staff.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts