Skin substitute Q-codes are among the most aggressively audited codes in dermatology. LCD non-compliance, missing wound measurement documentation, and incorrect stacking combinations cost practices their reimbursements — and sometimes trigger repayment demands.
We track LCD policies by MAC jurisdiction and update our billing rules each quarter. If your MAC has tightened coverage criteria, we know before your next claim goes out.
Human-derived skin substitutes. High audit frequency due to cost. Require wound measurement, diagnosis, prior care failure, and physician attestation per LCD.
Processed human or animal tissue products. LCD compliance varies by MAC. Must document size, application frequency, and medical necessity separately.
Synthetic or biologic-based. Often requires prior treatment failure documentation for at least 30 days of standard care before coverage is triggered.
We don't just code and submit. We run a pre-claim LCD compliance check on every skin substitute application before the claim leaves our desk — because a denial costs more than the check.
We'll review your current skin substitute billing for LCD compliance gaps — free, with a written summary of findings.