LCDs appear to be delayed until 1/1/26 based on MAC websites changing the revision effective date. More news as I get it. There’s now an amniotic that is over $5,000 per cm2. I wonder how high the prices will go by next January?
CMS Statement on Local Coverage Determination for Certain Skin Substitute Grafts | CMS
I have updated the figure in this article with new product pricing:
click image to enlarge
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
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What a cluster this has become. They could easily implement the reimbursement model from HOPD setting to private practice setting that would at least slow the hemorrhage of Medicare funds. That would be a set reimbursement amount for all applications regardless of product/size – for those unaware. Yes, it would limit the size wound you could tackle with grafts – but it’s something.
I worked at a major distributor that made billions off of these grafts, and it took me about two months to figure out that the mobile wound care clinics they are selling to (Vohra was the big one) are blatantly exploiting the system. It became so embarrassingly obvious when we were sending Grandpa millions of dollars worth of grafts to addresses all over the country, and then they just disappeared from the order sheets months later. I guess they were cured after their 50th graft. This specific company went from a humble little startup to a multi-international conglomerate where the owner is attempting to transition into other fad medical breakthroughs like cellulite removal and purchasing bankrupt breast implant companies. Thanks to all of the seniors who needed 50 grafts applied to a scrape on their foot and to all of the no-name consignment orders being shipped to random rich suburban neighborhoods across the US for making this happen! Very surreal to be one of the earlier people to start at that company and then to periodically look this up and see how much it has escalated. Don’t even get me started on the sales reps; some of the fakest and most plastic people you’ll ever meet who possess minimal medical knowledge about the products and have zero literature to prove their effectiveness (they are on the naughty list you mentioned.) The bottom line is that a group of people in wound care are making a lot of money (BILLIONS for easy work compared to traditional pharma) to exploit this loophole. This delay comes as no surprise and I assume people/lobbyists in DC will benefit from this fruitful scam.