Skin Substitute Access and Payment Reform Act

This bill would add skin substitute products, which are materials applied to a wound and meant to stay in the wound bed, as a covered benefit under Medicare Part B. Starting in 2026, Medicare would pay a single rate per square centimeter for all such products, based on a volume-weighted average of 2023 payment limits, and would raise that rate each year by inflation. Medicare would pay 80 percent of the lesser of the actual charge or that rate, and the Secretary of Health and Human Services would create one billing code for all skin substitute products. Every two years, the Secretary would identify and publicly list the 3 percent of providers who received the most Medicare payment for these products, refer the list to the Inspector General, and subject those providers to prepayment claim review and prior authorization. Providers whose prior authorization requests are denied more than 75 percent of the time for six or more months could have their billing privileges found abusive and be referred for possible exclusion from federal health programs.

Full text and official record on Congress.gov

Sponsors

• Earl L. "Buddy" Carter Republican sponsor
• 8 cosponsors