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Fore Skin Alternative Payment
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Fore Skin Alternative Payment

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The Model focuses on testing the implementation of prior authorization and pre-payment review for selected items and services including skin and tissue substitutes. CMS's stated goal is to streamline medical necessity reviews earlier in the claims process to:#Learn how CMS's 2026 skin substitute payment reforms change Medicare reimbursement, what providers need to know, and the impact on value-based care strategies.^During the Town Hall, CMS requested feedback from the public on specific questions related to changes in payment and terminology of skin substitute products under the Physician Fee Schedule (PFS).`For payment purposes, CMS treats skin substitutes like approved prescription biologics and skin substitutes are reimbursed in non-institutional Part B settings at 106 percent of the average sales price (ASP).-CMS has proposed significant changes to the reimbursement model for skin substitutes, marking one of the largest shifts in advanced wound care policy.@Organizations may see certain telehealth flexibilities become permanent, according to the 2026 Medicare Physician Fee Schedule (MPFS) proposed rule, released July 14. The proposed rule also details significant changes to professional reimbursement based on site of service, skin substitute payments, behavioral health services, and more.%SmartTRAK's industry experts discuss CMS' proposed changes to skin substitutes reimbursement and their potential effects on wound care practices. On Monday, July 14, the Centers for Medicare & Medicaid Services (CMS) released new proposals for the reimbursement of Skin Substitutes in the physician fee schedule sites of care. SmartTRAK estimates the 2024 US Skin Substitutes Market at almost


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