Medicare to standardize payments for wound-healing skin substitutes in 2026
In committeeH.R. 5768Latest action
Sponsor: Earl L. "Buddy" Carter · Representative · GA
AIDecoded by AI · checked against the recordRead the official text
Official title: Skin Substitute Access and Payment Reform Act
119th Congress
Topics: Health care
Introduced:
Read the official bill on Congress.govIn plain words
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Starting in 2026, Medicare would pay one standardized rate for skin substitute products instead of widely varying prices.
55-second read · 5 questions answered below
What does this do?
Starting in 2026, this bill sets a single Medicare payment rate for "skin substitute products" based on average 2023 prices, adjusted yearly for inflation, and creates one billing code to replace the many currently used. Beginning in 2025, Medicare would flag the top 3% of billing providers for fraud investigation, requiring extra claim reviews or prior approval unless they show a strong record of legitimate claims. In 2026, Medicare would also be barred from denying coverage for a specific product based solely on clinical research review, unless there's evidence it's unsafe.
Who does it affect?
Medicare patients with chronic wounds like diabetic ulcers or burns, the doctors and wound-care clinics using these products, and the manufacturers that make them.
Why does it matter?
The changes respond to concerns that current pricing variation has invited overbilling; providers will face new billing codes, possible audits, prior-approval requirements, and potential referral for removal from federal health programs if abuse patterns emerge.
What does it cost, and who pays?
- Standard 20% patient share applies
- Based on new 2026 flat rate
- Replaces current variable pricing
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Where does it stand?
- IntroducedOct 17, 2025
- House committeeYou are here · Oct 17, 2025
- House vote
- Senate
- The president's desk
Right now: a House committee is reviewing it. If the Senate changes it, it goes back to the House before reaching the president.
Latest action: — Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.