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H.R. 5768119th CongressIn committeeLatest action Oct 17, 2025Decoded by AI · checked against the record
Official title: Skin Substitute Access and Payment Reform Act
Introduced:
Read the official bill on Congress.govThe plain-language version leads. The official text is always the reference.
Starting in 2026, Medicare would pay one standardized rate for skin substitute products instead of widely varying prices.
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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.
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.
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.
AI-drafted summary. Verify it against the official text before you act on it. Read the official bill on Congress.gov
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.