by Caroline Fife, M.D. | Sep 9, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Dr. Fife – Here’s a new and surprising reason for denial of Medicare payment by Novitas Solutions for amniotic tissue applied to a chronic ulcer. The reason given that the products, “…are for infants and children.” I am providing 2 screen shots from the...
by Caroline Fife, M.D. | Sep 2, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Guest blog by Ryan Mathis On August 26, 2026, the court dismissed the CAMPs Initiative’s second lawsuit challenging the skin substitute reimbursement provisions of the Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule. Just like the first...
by Caroline Fife, M.D. | Aug 31, 2026 | Lymphatic Imaging & Lymphedema
Back to Basics: What We Still Need to Learn, and What We Will Need for the Future More than 25 years ago, I got a call from a woman who introduced herself as an engineer and said, “I hear you have a lot of lymphedema patients.” Boy, did I have a lot of lymphedema...
by Caroline Fife, M.D. | Aug 20, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitute Arrests, CTP / Skin Substitutes
The Department of Justice (DOJ) announced an indictment of a Nevada wound care physician for fraud in relation to expensive amniotic allografts. (Note that the conduct described below is alleged. Criminal charges are accusations, not findings of guilt.) The...
by Caroline Fife, M.D. | Aug 10, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
In October 2025, Michael Crouch posted a guest blog about a Medicare audit of skin substitute/CTP claims outlining some very interesting reasons for the denial of charges, including: The products used are amniotic membrane allografts. The amniotic membrane acts as a...
by Caroline Fife, M.D. | Jul 31, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
As Michael Crouch detailed in his 3-part guest blog, Medicare providers under audit may face a lengthy administrative appeals process before obtaining a hearing or review by an Administrative Law Judge (ALJ): The Incredible Journey: Lessons Learned from a “Skin...
by Caroline Fife, M.D. | Jul 29, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Subscribers to CMS (Centers for Medicare and Medicaid Services) listservs recently got a very short email announcing that CMS is reopening the call for clinical evidence on skin substitutes. I’d provide a link to the bulletin – but there isn’t one! It was simply...
by Caroline Fife, M.D. | Jul 22, 2026 | Fight the Good Fight
The Physician Fee Schedule proposed rule is out. Remember that like the OPPS proposed rule, there’s a comment period and possible changes before this is finalized. Here are the links you need to read things yourself. CMS is inviting comments on all these proposals and...
by Caroline Fife, M.D. | Jul 20, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The Subcommittee on Health Care and Financial Services Chairman Glenn Grothman (R-Wis.) announced a roundtable on “Medicare Fraud: Examining the Explosive Growth in Skin Substitute Spending”. DATE: Tuesday, July 21, 2026 TIME: 2:00p.m. ET LOCATION: 2154 Rayburn...
by Caroline Fife, M.D. | Jul 17, 2026 | Medicare Audits
I have gotten quite a few emails and calls from readers (and their attorneys) about audits focused on skin subs and debridements. Many practitioners simply do not have sufficient documentation to defend the denied claims and honestly, there’s...
