Recently someone passed on what a clinician had told them about the Cellular Tissue Products / Skin Substitutes that they were using. The clinician said they were not worried about being paid for a particular product because it had an established ASP (Average Sales Price). Medicare certainly uses the ASP when determining how much they will pay for a given product when used in the office-based setting. That is true. However, after Feb 12, 2025, the ASP does not mean that a product is covered by Medicare – at least for diabetic foot ulcers and venous leg ulcers. What the regional MACs will do with claims for wound types other than DFUs and VLUs (such as pressure ulcers) – I don’t know.
The final LCD(s) were released November 14th, but 6 days later, a rep for one of the many “non-covered” products was sending out an email blast to explain how Medicare “fully covers wound care grafts, removing any risk for [product name I won’t mention].” I wonder what their marketing will look like 12 weeks from now?
(Here’s a link to the covered and non-covered list.)
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
