The Medicare Advantage Medical Policy applies to certain wound treatments, skin substitutes

Last modified: Sept. 1, 2024
Update: We updated coverage summary to medical policy in the headline and article. We also added a link to the frequently asked questions.

Our Skin Substitutes Grafts/Cellular and Tissue-Based Products (Injections and/or Applications) medical policy applies to UnitedHealthcare® Medicare Advantage plans. This medical policy follows CMS LCDs/LCAs, where applicable.

For states/territories with no LCDs/LCAs, the medical policy directs providers to the UnitedHealthcare Commercial and Individual Exchange Medical Policy: Skin and Soft Tissue Substitutes to determine if the skin substitute to be used will be covered. Based on a review of medical claims, if the coverage criteria are not met or records are not submitted (if requested), claims may be denied.

Questions?

For additional information, see our Skin substitutes wound treatments: Medicare Advantage and Dual Special Needs Plans frequently asked questions.

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