Skin Substitute Access and Payment Reform Act

This bill ensures Medicare covers and pays for skin substitute products (used in wound care) by creating a new payment system starting in 2026. It establishes a payment rate based on a volume-weighted average of past payment data, adjusted annually for inflation, and requires a new billing code for these products by January 2026. The bill also adds program integrity measures: identifying the top 3% of providers by payment volume (outliers) for extra review, and requiring prior authorization for their claims starting in 2027. Additionally, it mandates coverage for these products in 2026 unless unsafe, and prohibits denying coverage solely based on clinical evidence analysis.