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Adds a new subparagraph in paragraph (1) to direct that skin substitute products be paid according to a new paragraph (9), and adds paragraph (9) establishing a volume-weighted average payment allowance limit methodology (effective 2026) and annual CPI-based updates beginning 2027.
Adds a new subparagraph (J) defining 'skin substitute product', requires establishment of a consolidated billing and payment code by Jan 1, 2026, and imposes special rules regarding reasonable and necessary determinations and reporting of average sales price.
Creates a single Medicare Part B payment method and billing code for skin substitute products used to treat chronic, non‑healing wounds. Payment will start January 1, 2026, based on a volume‑weighted average of reported late‑2023 payments and billed units, with annual cost‑of‑living increases beginning in 2027. The bill also requires a single billing code, manufacturer reporting, and certain coverage/payment rules to standardize payments and contain costs while recognizing clinical value.
Read twice and referred to the Committee on Finance.
Introduced July 31, 2025 by Bill Cassidy · Last progress July 31, 2025
Read twice and referred to the Committee on Finance.
Introduced in Senate