Building a Wound Care Practice: Are Cellular Tissue Products Worth Using?

Cellular tissue products have been all the rage for the last several years as many biotechnology firms have marketed these products to podiatrists. While the clinical outcomes speak for themselves, with many patients experiencing great outcomes with limbs salvaged, podiatrists like many physicians have seen a rise in income with their use.

While the bottom line is apparent to some, let’s take a closer look at it. There are many skin substitute/cellular tissue products on the market. The reimbursement that a DPM will receive is based on 2 different factors. The CTP can have an average sale price (ASP) or an WAC (wholesale acquisition cost)/invoice. Of the 68 available CTP available for use, Medicare was unable to calculate the ASP for 30 of the products because the company did not disclose it. What does that mean? The reimbursement for those products that are billed to CMS based on their WAC/invoice, instead of their ASP are reimbursed at a higher level. What does that mean? It means that the use of these products cost CMS more and therefore opens the user (DPM) to more scrutiny based on that reimbursement.

In March 2023, Anne Maxwell of The Office of the Inspector General of the US Department of Health and Human Services put out their report Some Skin Substitute Manufacturers Did Not Comply with New ASP Reporting Requirements.  

In the report, Medicare reimbursed over $256 million dollars for the skin substitutes that are reimbursed based on WAC/invoice pricing, while they reimbursed $132 million dollars for the skin substitutes based on ASP. 

For those of you who wish to build a wound care practice, these reimbursement numbers can have a large affect on your bottom line. Here are some considerations:

  • Be realistic in your reimbursement expectations.
  • Do your due diligence on the companies and products.
  • Don’t take everything the company says for face value.
  • Ask the company if CMS bases the reimbursement for their product on WAC/invoice pricing vs. ASP.

Lastly, make sure your documentation is what it should be. Perform internal audits on your charting to make sure you are documenting correctly. Make sure you are billing correctly, considering waste and using modifiers correctly.