Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities

Skin substitute graft application is covered for lower‑extremity diabetic foot ulcers and non‑infected venous leg ulcers that have failed appropriate conservative wound care (DFU >4 weeks; VLU 4–6 weeks) and when comprehensive assessment, documented treatment plan, and clinician management are present. Coverage is limited to one specified product per 12‑week episode (with repeat or product switches allowed only with documented reassessment and justification), and applications are contraindicated for uncontrolled systemic disease, active infection, certain active local conditions (e.g., Charcot, vasculitis), or known hypersensitivity to product components.

"Application of a skin substitute graft is covered for neuropathic diabetic foot ulcer(s) that have failed to respond to documented conservative wound-care measures for greater than 4 weeks."

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