
Understanding Medicare Reimbursement
Medicare covers biologic wound care products such as skin substitutes and biologic dressings when they are deemed medically necessary. Coverage is governed by:
- Local Coverage Determinations (LCDs) created by regional Medicare Administrative Contractors (MACs)
- CPT codes used to bill for services such as graft application and debridement
- Setting of care, which impacts allowable reimbursement rates (physician office, ASC, or hospital)
- Average Sales Price (ASP) for certain skin substitutes, influencing Medicare Part B payments