Local Coverage Determinations(LCDs) & Medicare Coverage for Wound Care Solutions
New LCDs for skin substitutes go into effect April 14th, 2025.
Centurion Therapeutics: Medicare-Covered Wound Care Solutions
Centurion Therapeutics is a leading provider of Medicare-approved wound care solutions ensuring that patients and healthcare providers have access to reimbursable, high-quality solutions. Our solutions are covered under the latest Local Coverage Determinations (LCDs) issued by the Centers for Medicare & Medicaid Services (CMS), making them eligible for reimbursement.
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Centurion is proud to announce the approval of both AmnioBand and AlloPatch under the new LCDs
What is Local Coverage Determination?
A Local Coverage Determination (LCD) is a decision made by Medicare Administrative Contractors (MACs) to establish which medical services and solutions are covered and reimbursed under Medicare Part A and Part B. These policies define medical necessity criteria, ensuring that only effective and essential treatments are reimbursed.
CMS LCD Decision & Reimbursement for Wound Care
Recent CMS LCD decisions have expanded Medicare coverage for advanced wound care solutions, including AmnioBand® and AlloPatch®. This decision significantly benefits patients with venous leg ulcers (VLU) and diabetic foot ulcers (DFU), ensuring they receive clinically proven treatments without financial burden.
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AmnioBand Coverage Under New LCD: Medicare now reimburses AmnioBand wound care solutions under the latest LCD updates, providing enhanced access to bioengineered tissue solutions for wound healing.
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AlloPatch Coverage Under New LCD: AlloPatch has also been approved under recent LCD Medicare coverage decisions, making it a valuable treatment option for chronic and non-healing wounds.
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CMS LCD Decision for VLU & DFU: Medicare recognizes VLU and DFU treatments as medically necessary under updated LCDs, allowing for reimbursement of specialized wound care solutions.
What do the new LCDs address?
The new wound care LCDs primarily address the use of cellular and tissue‐based products (CTPs), often called skin substitutes, for treating diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs). Here’s a high‐level overview of the key updates:
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Refined Clinical Criteria:
• The old “failure to respond” criterion has been replaced by a requirement that the ulcer must show less than a 50% reduction in area after an appropriate period of standard care.
• This change provides a more quantifiable trigger for when advanced therapies should be considered.
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Expanded Treatment Flexibility:
• The allowable number of applications has increased from 4 to 8 over a treatment episode, and the duration has been extended from 12 weeks to 16 weeks.
• These adjustments are based on clinical evidence and expert input, aiming to better reflect real‐world practice.
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Enhanced Documentation and Coding Requirements:
• New documentation guidelines include the use of a KX modifier when more than 4 applications are used, ensuring that any additional treatments are clearly justified as medically necessary.
• There are also updated requirements for documenting product wastage and selecting the appropriate product size, with added ICD‑10 code clarifications provided in the accompanying Billing & Coding Articles.
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Alignment and Consistency Across MACs:
• All Medicare Administrative Contractors have now aligned their final LCDs and coding guidelines to ensure consistent coverage policies nationwide.
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Implementation Timing:
• Although originally scheduled to take effect on February 12, 2025, the effective date for the LCDs has been postponed by 60 days—to April 13, 2025—to give providers additional time to prepare for the changes.
• (Note that some Billing & Coding Articles may still reflect the earlier date until they are updated.)
Overall, these revisions are designed to offer clearer clinical guidance, more treatment flexibility, and robust documentation requirements that reflect current wound care practices while ensuring that Medicare beneficiaries continue to have access to effective, evidence‑based therapies.