Printer Friendly Version

Contractor Information

Contractor Name: Palmetto GBA - Full list of policies of this Medicare Contractor Contractor Number: 11202 Contractor Type: MAC B

LCD Information

LCD ID Number: L39806 Status: A-Approved LCD Title: Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers Geographic Jurisdiction: South Carolina Other Jurisdictions Original Determination Effective Date: 01/01/2026 Original Determination Ending Date: Revision Effective Date: Revision End Date: CMS National Coverage Policy: This LCD supplements but does not replace, modify, or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for skin substitute grafts/CTP for the treatment of DFU and VLU. Federal Statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify, or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions, and scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations, and rules for Medicare payment for skin substitute grafts/CTP for the treatment of DFU and VLU and must properly submit only valid claims for service and products utilized. Please review, understand and apply the necessity provisions in the policy according to the Manual guidelines. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site: CMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, §50.4.1 Approved Use of Drug CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §270.3 Blood-Derived Products for Chronic Non-Healing Wounds, §270.4 Treatment of Decubitus Ulcers and §270.5 Porcine Skin and Gradient Pressure Dressings CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 13, §13.5.4 Reasonable and Necessary Provisions in LCDs Title XVIII of the Social Security Act, §1862(a)(1)(A) states that no Medicare payment may be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury. Title XVIII of the Social Security Act, §1862(a)(7) excludes routine physical examinations. 21 CFR, Part 1271 - Human cells, tissues, and cellular and tissue-based products Sorry, you need to login or register to view additional sections of this Medicare policy. *