CMS Updates on Skin Substitutes for 2025
Now known as Cellular and/or Tissue Based Products (CTPs), these repurposed and re-engineered products fall under the Tissue Engineering Products category. The CMS is updating policy structures across all healthcare services in phases – here’s what you need to know.
1. Nationwide Local Coverage Determinations (LCDs)
Also, Medicare contractors estimated to include policies will be effective from February 11, 2025, as follows:
Replacing vague comments such as ‘Failure to respond’ with agreeable statements ‘50% ulcer area reduction’ as a target. Increasing application limits between 4 to 8 and extending the duration range to between 12 and 16 weeks. providing guidelines for vascular assessment and contraindication of appropriate therapies.
2. Modifier Requirements
The Centers for Medicare Services has updated the billing modifier requirements to define them more deliberately.
KX Modifier: For more than four applications during the treatment period.
JW Modifier: Documents portions of products that have been purchased but not used, as in the case with single use products.
JZ Modifier: Certifies that there was no waste that occurred during the course of the procedure.
3. High-Cost vs Low-Cost Classification
CTPs remain classified as high-cost or low-cost for reimbursement purposes. The high-cost products are linked to CPT codes 15271–15278, while low cost products correspond to HCPCS codes C5271–C5278. These classifications ensure appropriate payment under both the Physician Fee Schedule (PFS) and the Outpatient Prospective Payment System (OPPS).
How Revantage Healthcare make Wound Care Billing Easy
Wound care billing could be a headache but not with Revantage Healthcare. We offer a solution for your billing from claim submissions to compliance so that you can take care of your patients. Working with wound care billing can be quite difficult, and that is why Revantage Healthcare works to make it easier for you. We manage each part of your billing cycle, right from submitting the claims and complying, to allowing you to shift your focus to your patients.
Services Include:
Accurate Billing and Coding: Ensuring correct documentation and use of modifiers like -KX,
JW, and JZ.
∙Compliance Expertise: Staying updated on CMS policies, including LCDs and HCPCS
classifications.
∙Comprehensive Documentation Support: From wound measurements to justification for
repeated applications.
∙Streamlined Claim Submissions: Managing appeals and follow-ups for timely
reimbursements.
