by Caroline Fife, M.D. | Jan 27, 2026 | Field Test Report, Quality Payment Program
Official CMS press release: The Centers for Medicare & Medicaid Services (CMS) and its contractor, Acumen, LLC, will conduct field testing from January 29 to February 27, 2026, for three episode-based cost measures. The measures will undergo field testing before...
by Caroline Fife, M.D. | Jan 26, 2026 | Field Test Report, Healthcare Payment Policy, Quality Payment Program
This is an official CMS release: Upcoming Specialty Society Office Hours We are holding office hours with specialty societies and organizations to provide information about the upcoming field testing period. These office hours are intended as an informal opportunity...
by Caroline Fife, M.D. | Jan 26, 2026 | Field Test Report
First in an Ongoing Series About the Field Test I have been longing to think about something other than CTPs/skin subs, but believe me that another attempt by CMS to create a “non-pressure ulcer” cost measure was not what I wanted to think about. This subject is a...
by Caroline Fife, M.D. | Jan 21, 2026 | Fight the Good Fight
One of my favorite songs is “A Puzzlement” from “The King and I,” because, as the song says, “I am no longer sure of what I absolutely know.” At least I am no longer sure of what I have been taught. We are taught that there are wounds, and then there are ulcers...
by Caroline Fife, M.D. | Jan 16, 2026 | Pyoderma Gangrenosum
Let me say at the outset that I love my pharmacist, Calvin, who is a wealth of knowledge. And, often when I have phoned in a prescription for a patient, the pharmacist to whom I spoke has warned me about a potential drug interaction that I didn’t know about and been...
by Caroline Fife, M.D. | Jan 15, 2026 | Fight the Good Fight
I attended the Noridian informational call on the WISeR model. They provided the content of the slides with permission to share as follows: This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety,...
by Caroline Fife, M.D. | Jan 9, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Uncategorized
I understand why CMS did it. There has been wild abuse of the Cellular Tissue Product (CTP) / skin substitute wastage code. The payment model incentivized practitioners to use large pieces even on small wounds, because they could get paid for the amount they wasted....
by Caroline Fife, M.D. | Jan 6, 2026 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
CMS has updated its FAQs on the JW and JZ modifiers. These FAQs clearly state that Medicare fee for service (FFS) does not pay for discarded amounts of “incident to supplies” (which is how all non-BLA CTPs/skin subs are now classified) and will only pay for the amount...
by Caroline Fife, M.D. | Dec 29, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
It was downright hot in Texas for Christmas (~80° F) but for New Year’s Eve, the storms battering the northeast are making their presence known as far south as Houston and the temperature has dropped 40 degrees in a few hours. The “skin substitute” market has been as...
by Caroline Fife, M.D. | Dec 25, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The CMS newsroom just released this press release yesterday, announcing that Final Local Coverage Determinations (LCDs) for Certain Skin Substitutes Have Been Withdrawn. Effective immediately, CMS’ A/B Medicare Administrative Contractors (MACs) are withdrawing the...
