Clinical Coverage Policy Update 1G-2 Skin Substitutes

Effective April 1, 2025: NC Medicaid amended Clinical Coverage Policy 1G-2.

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

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