CME Online Presents: What is going on with CMS and Skin Substitutes
Medicare spending on wound care products known as “skin substitutes” has had unprecedented growth, rising from $256 million in 2019 to over $10 billion in 2024, according to Medicare Part B claims data. This dramatic increase is largely attributed to abusive pricing practices in the sector, including the use of products with limited evidence of clinical value. This has led to a significant decrease in reimbursements and a significant increase in audits performed by CMS. This presentation will focus on the rules and regulations that now must be followed.
At the completion of this presentation, attendees will be able to:
1. Describe the January 1, 2026 payment change establishing a flat national rate of $127.14 per square centimeter for most skin substitutes.
2. Explain the CMS WiseR model and its relevance to wound care reimbursement.
3. Identify the elimination of Medicare reimbursement for unused or discarded skin substitute portions and the discontinuation of JW and JZ modifier use.
4. Apply appropriate use of the KX modifier when more than four applications occur within a treatment episode with documented clinical improvement.
5. List the required components of a compliant 2026 wound care encounter note, including medical necessity, wound assessment, product details, procedure description, and administered versus discarded amounts.
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The information contained in this presentation does not establish a standard of care, nor does it constitute legal advice.
The information is for general informational purposes only and is prepared from a perspective to aid in understanding the pathology.
In accordance with the Council on Podiatric Medical Education's Standards and Requirements for Approval of Providers of Continuing Education in Podiatric Medicine, any relevant financial relationships with commercial interests of faculty, planning committee, or any others who have influence over the content of this educational activity must be disclosed to program participants. There are no conflicts of interest to disclose for this program
Commercial Interests: No commercial interest provided financial support for this continuing education activity.
In accordance with the Council on Podiatric Medical Education's Standards and Requirements for Approval of Providers of Continuing Education in Podiatric Medicine, any relevant financial relationships with commercial interests of faculty, planning committee, or any others who have influence over the content of this educational activity must be disclosed to program participants. There are no conflicts of interest to disclose for this program
CME Online is approved by the Council on Podiatric Medical Education as a provider of continuing education in podiatric medicine. CME Online has approved this activity for a maximum of 1.5 continuing education contact hours.
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