NC Medicaid has amended Clinical Coverage Policy 1G-2, Skin Substitutes. This update includes the addition of Kerecis® (Q4158), which was approved for coverage Feb. 1, 2025.
About Kerecis
Kerecis is a fish skin graft derived from decellularized Atlantic cod that is used to treat wounds and support tissue regeneration.
Policy Criteria
Criteria for Kerecis included in the 1G-2 policy is as follows:
- The application limitation for Kerecis® is one application per calendar week, for a maximum of 12 weeks per ulcer.
- Documentation of the amount of product units discarded and the reason for the wastage is required.
- Kerecis® must be billed with applicable CPT codes that describe tissue application and preparation of the site.
- Approved Places of service:
- Inpatient hospital
- Outpatient hospital
- Office setting
- Coverage Clinical Indications:
- Diabetic Foot Ulcers (DFUs): Partial or full thickness greater than four weeks in duration, extending through the dermis (with or without exposure of tendon, muscle, joint capsule, or bone).
- Venous Status Ulcers (VSUs): Partial or full-thickness ulcers of greater than four weeks duration, extending through the dermis (with or without exposure of tendon, muscle, joint capsule, or bone).
- Burns
- For the full policy details, refer to the updated Clinical Coverage Policy 1G-2.
Contact
NC Medicaid Contact Center: 888-245-0179