Skin Substitute Access and Payment Reform Act of 2025

This bill changes how Medicare pays for “skin substitute” products used to help chronic wounds heal, like diabetic foot and leg ulcers. It aims to make prices more consistent, lower costs, and keep access to effective treatments. Lawmakers note these products can reduce amputations, that many types work similarly, and that current rules encourage use of higher-priced products and rising costs .

Starting January 1, 2026, Medicare would pay one standardized amount for each skin substitute brand, based on a volume‑weighted average of late‑2023 prices and use. From 2027 on, that amount would adjust each year with inflation. The bill also sets one new billing code for all skin substitutes, uses the same coverage rules across products unless one is proven unsafe, and says Medicare can’t call a product not “reasonable and necessary” based only on a review of clinical evidence. It defines what counts as a skin substitute and excludes temporary dressings and items like liquids or gels. Manufacturers would not have to report average sales prices for these products .

• Who is affected: Medicare patients with chronic wounds; clinics and doctors who apply skin substitutes; product makers .
• What changes: A single pricing method, one billing code for all skin substitutes, uniform coverage rules, and no ASP reporting by manufacturers .
• When: New payment and coverage rules begin January 1, 2026; annual inflation updates start in 2027 .