Skin Substitute Access and Payment Reform Act

Key Provisions

• Adds skin substitute products to Medicare Part B coverage, starting January 1, 2026.
• Sets a new, standardized payment method for skin substitutes based on past prices and usage, with annual inflation updates, starting January 1, 2026.
• Requires the government to identify the 3 percent of providers who bill Medicare the most for skin substitute products every two years.
• Requires extra checks, like prepayment review and prior authorization, for these top billing providers.
• Provides $5,000,000 each year from 2027-2030 to manage the prior authorization program for skin substitutes.
• Mandates a new, single billing code for all skin substitute products by January 1, 2026.