CMS Revises WISeR Guidance for Skin Substitute Reviews

CMS updated the WISeR Provider and Supplier Operational Guide to remove ICD-10 codes L97.111-L97.826 from Appendix B as indications that would automatically trigger prior authorization or pre-payment review for skin substitute applications. These diagnosis codes are commonly used to describe non-pressure chronic ulcers of the lower limb and are not exclusive to diabetic foot ulcers (DFUs) or venous leg ulcers (VLUs).

Previously, providers in WISeR states could unintentionally trigger review for skin substitute applications furnished for ulcer types outside the intended scope of the model (only applicable to DFUs and VLUs) simply because the same diagnosis codes were used. The update appears intended to better align WISeR implementation with CMS's stated focus on DFUs and VLUs and may reduce inappropriate prior authorization and pre-payment review triggers for other wound types.

APMA will continue engaging with coalition partners and stakeholders regarding WISeR implementation challenges.

Contact the APMA Advocacy Department with any questions at [email protected].