CMS Proposes New Coverage Determination for Skin Substitute Grafts: What Healthcare Providers Need to Know
CMS Proposes New Coverage Determination for Skin Substitute Grafts: What Healthcare Providers Need to Know
The Centers for Medicare & Medicaid Services (CMS) and Medicare Administrative Contractors (MACs) have announced a proposed Local Coverage Determination (LCD) for skin substitute grafts and cellular and tissue-based products (CTPs). Released on April 25, 2024, this proposal impacts the treatment of chronic non-healing diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs).
This proposed policy aims to ensure that Medicare beneficiaries receive treatments supported by evidence-based guidelines while maintaining access to necessary wound care services. Stakeholders, including providers, manufacturers, and advocacy groups, are encouraged to participate in the ongoing feedback process.
The Role of the Alliance of Wound Care Stakeholders
The Alliance of Wound Care Stakeholders has played a significant role in influencing these LCD proposals. Their advocacy ensured that the wound care community’s feedback was considered in the final policy. Notably, the MACs adopted recommendations that led to:
Increased Application Limits: From 4 to 8 applications, aligning with clinical evidence and standard care guidelines.
Extended Treatment Duration: From 12 weeks to 16 weeks, providing more flexibility for hard-to-heal wounds.
These changes reflect substantial improvements that support better patient outcomes and allow providers the necessary flexibility for treatment.
What’s Included in the Proposed LCD
Public Comment Period: Open until June 8, 2024. Providers and stakeholders are encouraged to submit feedback to their respective MACs.
Public Listening Sessions: Scheduled for May 2024, offering opportunities to engage directly with MACs.
Coverage Changes: The final policy covers 18 HCPCS codes – 13 for DFU-specific treatments and 5 for DFU/VLU treatments.
While the policy represents progress, the Alliance of Wound Care Stakeholders has noted areas requiring further clarity, particularly around the process for submitting new evidence for products currently on the non-covered list. The Alliance is advocating for:
Transparent Timelines for submitting new evidence.
Clearer Processes for reviewing and updating coverage based on new data.
Next Steps for Providers
Adjust Practices: Providers should review the new coverage determinations and update their prescribing and documentation practices by the February 12, 2025 implementation date.
Participate in Feedback: Attend the upcoming MAC Town Hall on December 10, 2024, and share insights. Registration and speaking requests can be sent to J15MRPolicy@cgsadmin.com.
Stay Informed: Follow updates from the Alliance of Wound Care Stakeholders for ongoing advocacy efforts and policy changes.
For more information, visit the CMS Local Coverage Determination Process Page and stay connected with the Alliance of Wound Care Stakeholders through their advocacy efforts and news releases.
How Mevia Consulting Can Help
At Mevia Consulting, we understand the complexities of Medicare policy changes and their impact on healthcare providers. We offer:
• Compliance Consulting: Ensuring your practice adheres to the latest CMS policies.
• Operational Support: Helping you adjust workflows, documentation, and billing practices.
• Policy Updates: Keeping you informed on regulatory changes that affect wound care.
Contact us today to streamline your operations and stay compliant with evolving Medicare standards.
