Tissue-Engineered Skin Substitutes

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Page 1 of 159 Medical Coverage Policy: 0068 Medical Coverage Policy Effective Date ........................................ ... 11/15/2022 Next Review Date ....................................... 3/15/2023 Coverage Policy Number .................................. 0068 Tissue-Engineered Skin Substitutes Table of Contents Overview ........................................ ...................... 1 Coverage Policy ........................................ ........... 1 General Background ........................................ .. 24 Medicare Coverage Determinations ................ 109 Coding Information.

® Venous stasis ulcer Considered medically necessary when BOTH of the following criteria are met: • partial- or full-thickness venous stasis ulcer of greater than four weeks duration for which standard wound therapy has failed • treated lower extremity has adequate blood supply as evidenced by either the

  Ulcer, Venous