Billing and Coding: Skin Substitutes Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers

Medicare covers skin substitute grafts/CTPs (non‑autologous human, xenograft, and sheet-forming biologic products) for diabetic foot and venous leg ulcers only when they meet the LCD L39760 "reasonable and necessary" criteria, while non‑graft wound dressings and injected skin substitutes are excluded from separate payment and must not be billed with skin substitute graft application HCPCS/CPT codes. Providers must follow LCD documentation/coverage criteria and use the appropriate modifier when billing non‑covered services (GX for Part A voluntary ABNs, GY for Part B statutorily excluded items, GA when a waiver was issued and denial is expected, or GZ when no notice was issued and denial is expected).