Medicare Part B Payments for Skin Substitutes

Skin substitutes help aid in wound healing and redevelopment of skin. Medicare covers skin substitutes that are reasonable and necessary for the treatment of an enrollee's condition. Local coverage determinations state that Medicare Part B generally covers skin substitutes for treatment of diabetic foot ulcers and venous leg ulcers that have failed to respond to at least 4 weeks of standard wound care. However, no national or local coverage requirements apply for other wound types (e.g., pressure ulcers or trauma wounds), and coverage of skin substitutes for these wounds is determined on a case-by-case basis. Medicare Part B pays for skin substitutes based on the number of service units billed at prices ranging from approximately $100 to more than $1,000 per square centimeter. From calendar years 2020 through 2023, Medicare Part B payments for skin substitutes have increased substantially. We will review Medicare Part B claims for skin substitutes to identify payments that were at risk for noncompliance with Medicare requirements.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
November 2024	Centers for Medicare and Medicaid Services	Medicare Part B Payments for Skin Substitutes	Office of Audit Services	OAS-25-09-005	2026