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

This billing/coding guidance for LCD L39828 allows skin substitute grafts/CTPs (non‑autologous human grafts, xenografts, and sheet‑forming biological products) for diabetic foot and venous leg ulcers but excludes billing Medicare for non‑covered services and prohibits reporting graft application codes for non‑graft dressings or injected skin substitutes (those products are bundled and not separately payable). Key requirements: follow the LCD’s reasonable‑and‑necessary criteria, do not report application codes for gels/powders/ointments/foams/liquids or injectables, and use modifiers GX (Part A voluntary ABN/statutory exclusion), GY (Part B statutory exclusion), GA (ABN issued when denial expected as not reasonable/necessary) or GZ (no notice issued when denial expected) as appropriate.