01/06/2026
As of January 6, 2026, the Physician Fee Schedule is still not available on cms.gov. Whatever that means, I dont know...but for now, when it comes to the vast majority of skin substitutes, those are priced at $127.14 per square cm.
The question has been asked "what do we do with the waste if a product only comes in one size?" Well...you better find a product that has more sizes available! Here is what Medicare is saying:
Q9. Should the JW and JZ modifiers be used when billing for separately payable incident-to supplies?
A9. The JW and JZ modifiers are only used when billing for drugs and biologicals separately payable under Medicare Part B as described in FAQ 8.
The JW and JZ modifiers are not appropriate for billing for incident-to supplies, even if such incident-to supplies are separately payable.
In addition, discarded amounts of incident-to supplies are not payable by Medicare.
..non-BLA skin substitutes are no longer payable under Medicare Part B as a drug or biological as of January 1, 2026, and only the administered portion is payable.
For dates of service starting January 1, 2026:
• If a provider or supplier administers an entire non-BLA skin substitute from the package or container (and no units are discarded), the JZ modifier is not appropriate when billing Medicare.
• If a provider or supplier administers a portion of a non-BLA skin substitute from the package or container and a portion is discarded, the provider or supplier may only bill for the units that are administered. It is not appropriate to bill Medicare for such discarded units under any circumstance (that is, such units may not be billed with the JW modifier and such units may not be included when billing for the administered amount).
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