Skin and Tissue Substitutes - MEDICAID - VIRGINIA

This policy covers reimbursement for skin and tissue substitute products (e.g., Oasis Tri‑Layer/Oasis Wound Matrix, Transcyte, Grafix Core/Prime, Integra bilayer matrices/dermal templates) used as wound coverings, dermal scaffolds, or temporary grafts for chronic wounds, burns, and soft tissue reconstruction. Coverage is limited to specified indications—commonly chronic venous or diabetic partial‑ and full‑thickness ulcers, neuropathic diabetic foot ulcers, partial‑thickness and deep burns, and post‑excisional reconstruction—and generally requires prior failed standard wound therapy (typically ≥4 weeks), product‑specific restrictions (for many products no exposed bone/capsule/muscle/tendon), temporary use of Transcyte prior to autograft, and billing tied to specific HCPCS codes.

"Particulate products of the above-mentioned matrices (Neox Flo, Clarix Flo — product form)"