New Medicare Local Coverage Policies for CTPs/Skin Substitutes

We've Got You Covered

Clinical study results showed that 79% of patients with Wagner 3-4 achieve wound closure with an average of 1.24 applications.¹

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Are you aware of the current coverage policy change?

Hear from Tim Hunter, Vice President of Reimbursement & Government Affairs

Novitas: Arkansas, Colorado, Delaware, Louisiana, Maryland (Montgomery & Prince George’s counties), Mississippi, New Jersey, New Mexico, Oklahoma, Pennsylvania, Texas, Virginia (Arlington & Fairfax counties, Alexandria), Washington DC

See coverage policy LCD L35041 / LCA A54117

First Coast: Florida, Puerto Rico, & U.S. Virgin Islands

See coverage policy LCD L36377/ LCA A57680

CGS: Kentucky, Ohio

See coverage policy LCD L36690 / LCA A56696

Fewer Applications, Faster Healing.

If your practice is in one of the states affected by these changes, we’re here to help. Our coverage inclusion supports our vision of treating more patients, with higher healing rates with less applications in support of escalating healthcare costs in the patient population.

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Discover BioTissue’s advanced wound care products:

Neox 1K

Cryopreserved, ultra-thick human amniotic membrane allograft used as an adjunct treatment for chronic and acute, partial and full-thickness wounds.

Neox 100

Cryopreserved amniotic membrane allograft for wound applications, a thinner alternative to Neox 1K.

Neox RT

Hydrated, shelf stable, ultra-thick human amniotic membrane allograft.

Learn More How Neox Can Help You Navigate these Changes.

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Frequently Asked Questions

How does this coverage change impact your clinical practice?

Neox the CTP which you are currently utilizing is covered, your choice in advanced wound care product will not be impacted.
The LCD link provides products that are covered (Table 2) and non covered (Table 3)

Article – Billing and Coding: Skin Substitutes Grafts/Cellular Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (A56696) (cms.gov)

What are the Neox® covered Q Codes?

Q4148 Neox 1K, Neox RT and Clarix 1K per square cm
Q4156 Neox 100, Clarix 100 per square cm

Do these changes impact the number of applications of advanced wound care products?

The number of CTP applications will be capped at 4 versus the current allowable of 9.

Do you have evidence that supports a lower number of applications to wound closure?

Our coverage inclusion supports our value based proposition of less applications with a vision of treating more patients, with higher healing rates with less applications in support of escalating healthcare costs in the patient population.

Caputo WJ, Vaquero C, Monterosa A, Monterosa P, Johnson E, Beggs D, Fahoury GJ. A retrospective study of cryopreserved umbilical cord as an adjunctive therapy to promote the healing of chronic, complex foot ulcers with underlying osteomyelitis. Wound Repair Regen. 2016 Sep;24(5):885-893. doi: 10.1111/wrr.12456. PMID: 27312890.
Raphael A. A single-centre, retrospective study of cryopreserved umbilical cord/amniotic membrane tissue for the treatment of diabetic foot ulcers. J Wound Care. 2016 Jul 1;25(Sup7):S10-S17. doi: 10.12968/jowc.2016.25.Sup7.S10. PMID: 29027852.