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release yesterday, announcing that Final Local Coverage Determinations (LCDs) for Certain Skin Substitutes Have Been Withdrawn.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...
by Caroline Fife, M.D. | Dec 23, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The Medicare final rule on the payment policy for CTPs/skin substitutes discussed the possibility of creating different pricing structures based on the product’s FDA pathway – particularly for “BLA” products. I didn’t know there were any BLA products approved for...
by Caroline Fife, M.D. | Dec 16, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
CMS just released this fact sheet: Upcoming Update to the Final Local Coverage Determinations (LCDs) for Certain Skin Substitutes | CMS Upcoming Update to the Final Local Coverage Determinations (LCDs) for Skin Substitute Grafts/Cellular and Tissue-Based Products...
by Caroline Fife, M.D. | Dec 10, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
This is a belated Thanksgiving message, but it has taken awhile for me to think through the sweeping changes that happened to CTP/CAMP/skin substitute payments on the last day of October. Here’s a list of what I think are the positive impacts and I hope you will send...
by Caroline Fife, M.D. | Nov 20, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
This is the third installment of a post by Michael Crouch recounting in exhaustive detail one clinician’s journey through a 15-month audit on her use of “skin substitutes” (CTPs/CAMPs). Mr. Crouch’s 3-part article can serve as a blueprint for the hundreds of other...
by Caroline Fife, M.D. | Nov 17, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Dr. Fife – When we last left our clinician, whose CTP/skin substitute claims were being audited by a Unified Program Integrity Contractor (UPIC) and their Medicare Administrative Contractor (MAC), she had been told that allografts when applied to wounds were not...
by Caroline Fife, M.D. | Nov 5, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Do the Right Thing: Thoughts on Quality
Months ago, Medicare announced its intention to change the payment model for CTP/CAMPs and create a fixed payment rate of around $125/cm2. Many thought that the proposed payment rate would be increased substantially in response to Congressional lobbying. These efforts...
by Caroline Fife, M.D. | Nov 3, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Hi Caroline, I just read the great article by Mike Crouch on the UPIC audits around skin substitutes. We’re looking at a UPIC denial for a patient we successfully grafted last year. They claim we had no weekly measurements! Absurd!! They said we don’t measure wounds...
