Updates to Skin Substitute LCDs Effective January 1, 2026, and New Skin Substitute Resource Page

On December 15, 2025, CMS announced that all seven Part B Medicare Administrative Contractors (MACs) will issue updated final "Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers."

Local Coverage Determinations (LCDs) will be effective January 1, 2026. The LCDs will still only govern coverage of skin substitute application to diabetic foot ulcers and venous leg ulcers performed for Medicare Part B beneficiaries. The LCDs will still outline coverage criteria and documentation requirements for this service. The LCDs will list 18 products that are "covered" and 158 products that are "not covered." There will be a third list of 154 other products in the LCDs for which coverage will be at the discretion of the Part B MAC that has jurisdiction where the service was performed. For these products to be covered, they must meet the "reasonable and necessary" standard in section 1862(a)(1)(A) of the Social Security Act and any other applicable requirements. These lists can be viewed here.

Members can find all the information related to skin substitutes coverage and payment on APMA's new Skin Substitute Resource Page, which includes detailed videos covering the changes, the most current information on the future effective LCDs (and related coding and billing articles), information on the WISeR Model, and more. The most recently recorded video (Skin Substitute Policies Scheduled to Take Effect January 1, 2026) will be updated once the MACs have released final data.