CMS Announces New Skin Substitute Payment Methodology: Possible Next Steps
Summary: November 5, 2025 blog by Jeffrey D. Lehrman details CMS’s October 31, 2025 CY 2026 Physician Fee Schedule final rule: new payment for skin substitutes in non-facility settings/HOPD—volume-weighted average $127.28/cm² (Q4 2024 ASP data, OPPS-weighted) for non-351 HCT/Ps; separate procedure reimbursement; ASP for section 351 biologics. Shifts from individualized limits; no WISeR/LCD impact. Providers: review ASP files for limits; many below $127.28 may affect selection. Next steps: Access CMS ASP Pricing Files for HCPCS limits.
Key Highlights:
- Change: Unified average vs. prior separate approaches.
- Implications: Influences advanced product use; check profitability.
- Relevance: Affects reimbursement for synthetic/biologic matrices in chronic wounds.
Keywords: CMS skin substitute, payment methodology, 2026 PFS, reimbursement changes