A looming Medicare payment change could disrupt the national supply of advanced wound grafts used to treat chronic ulcers, triggering warnings from industry groups and new legislation from federal lawmakers.
The Medicare Access to Skin Substitutes Coalition said in a statement that a coverage change set to take effect Jan. 1, 2026, would eliminate reimbursement for many skin substitute products used in physician offices and home settings. The coalition said the rule could force companies out of the market and leave patients with diabetic foot and venous leg ulcers at higher risk of infection, amputation or death.
On Oct. 22, Reps. Buddy Carter, Marc Veasey, Greg Steube and Rich McCormick, MD, introduced the Skin Substitute Access and Payment Reform Act of 2025 — according to a news release from Mr. Carter’s office. The bill proposes delaying Medicare’s coverage determination and volume-based payment limits until Jan. 1, 2026. It also includes prepayment review and prior authorization requirements for high-cost providers.
Medicare spending on skin substitutes increased from $500 million in 2020 to $6.5 billion in 2024, with the top 100 billers accounting for $3.8 billion in 2023 claims tied to 5% to 6% of patients, according to the release.
More than 10.5 million Medicare beneficiaries receive care each year for chronic wounds. The lawmakers said their bill aims to preserve access to skin grafts with demonstrated clinical value while addressing outlier billing practices.
