CMS Proposes New Coding Changes for Skin Substitute Products in Wound Care
Summary: The Centers for Medicare & Medicaid Services (CMS) has proposed changes to how cellular and tissue-based products (CTPs), often called “skin substitutes,” are coded and paid for when used to treat skin wounds in physician offices. As part of the 2023 Physician Fee Schedule, CMS plans to discontinue Q-codes for skin substitutes by the end of calendar year 2023 and introduce “A” codes for products meeting HCPCS Level II criteria, effective January 1, 2024. The goal is to classify these products as “supplies incident to a physician service,” packaging their payment into the practice expense portion of the associated service. (Dermatology Times)
Key Highlights:
- Code changes: Replace existing Q-codes with A-codes for eligible skin substitute products under HCPCS Level II.
- Reimbursement structure: Skin substitute products will be treated as supplies “incident to” a physician service rather than via separate codes.
- Payment methodology: Products will continue to be reimbursed using the ASP+6 methodology during the transition period.
- Effective date: Proposed changes to begin January 1, 2024.
- Stakeholder concerns: Wound care provider groups warn that reduced payments may not match costs, potentially limiting access to skin substitute products for chronic wound patients, with possible downstream effects including infections or amputations.
Read the full article on Dermatology Times
Keywords:
CMS coding changes,
cellular tissue‐based products,
skin substitutes,
physician fee schedule,
reimbursement,
wound care providers