Noridian Removes Skin Substitute Draft Policy

Effective January 1, 2026, CMS removed the draft Local Coverage Determination (LCD) policy "Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers".

Skin substitutes will not be identified on the prior authorization lists. This affects the voluntary prior authorization program "Wasteful and Inappropriate Service Reduction (WISeR)" model for the Noridian states of Arizona and Washington.

Final CY2026 single payment rate for skin substitute products is approximately $127.28.

Reminder: JW and JZ modifiers are not appropriate for billing incident-to supplies starting January 1, 2026 to Medicare:

  • Provider administers entire non-biologic license application (BLA) skin substitute from package or container (with no units discarded); JZ modifier not appropriate
  • Provider administers portion of non-BLA skin substitute from package or container (portion discarded); only bill units administered
  • Not appropriate to bill Medicare for discarded non-BLA skin substitute units under any circumstance with JW modifier
Last Updated Jan 23 , 2026