CMS Announces New Skin Substitute Payment Methodology: Possible Next Steps
Summary: CMS finalized a volume-weighted average payment of **$127.28 per square centimeter** for most 361 HCT/P skin substitute products under Medicare Part B (non-facility and HOPD) starting 2026, based on Q4 2024 ASP data. This addresses rapid payment growth; section 351 biologicals retain ASP methodology. No impact on WISeR model or DFU/VLU LCDs. Many current payment limits fall below $127.28, potentially affecting product availability; providers should review CMS ASP Pricing Files to compare HCPCS limits and guide selection.
Key Highlights:
- Rate: $127.28/cm² volume-weighted ASP (Q4 2024).
- Scope: Part B non-facility/HOPD; separate application reimbursement.
- Exceptions: Section 351 biologicals use ASP.
- Next Steps: Download latest ASP file from cms.gov; check Column D limits vs $127.28.
- Implications: Viability check for products; non-Medicare payers may follow.
Keywords: CMS skin substitutes, 2026 payment, flat rate, ASP, DFU VLU