The bill would change Medicare payment rules for certain skin substitute products used in wounds. Starting January 1, 2026, Medicare would use one billing and payment code and set a payment amount based on a volume-weighted average of payment limits and units billed in the fourth quarter of 2023. The amount would increase each year starting in 2027 based on the consumer price index. The bill also sets common coverage criteria for these products, with an exception for products found unsafe for specified reasons.
If you receive Medicare care involving a product covered by the bill, the product would be paid under the new shared payment rules. The bill does not guarantee coverage for a particular treatment or change the role of a provider in choosing care for a patient.
The bill does not state a dollar amount. It sets a payment calculation based on 2023 payment limits and claims, with later annual increases tied to the consumer price index. No publicly available information.
The bill's findings say payment rules should recognize the clinical value of skin substitute products while containing costs, and that current payment rules can encourage use of more expensive products. No publicly available information about individual proponents' views.
No publicly available information.