I have a patient that has a right plantar wound that has not decreased more that 50% at 4 weeks.

Additionally, patient has a wound on right 2nd toe, and MRI results are positive for acute osteomyelitis. Patient was treated with antibiotics and had toe amputated. Is there any contraindications for skin substitute to right plantar wound with no signs of infection, while patient is on antibiotics.

Dec 18, 2024 by Marlen Caballero, APRN, AGACNP

3 replies

Kim Simonson
RN-BC, ACHRN, CWS, FACCWS

Hello Marlen,

Thank you for your question.

CMS has recently released their 2025 final rule regarding criteria for reimbursement of CTPs. The criteria for a DFU includes "infection control with removal of foreign bodies or focus on infection" as part of the documented treatment plan.

According to your description, the plantar wound appears to have no signs of infection and meets the criteria of no decrease in size greater than 50% in 4 weeks of standard treatment. If all additional required criteria are met, this patient meets eligibility for DFU CTP placement with a product approved for DFUs.

Recommendations by the LCDs include to evaluate and document healing progress and signs and symptoms of infection on each visit, and also to discontinue the CTP if signs of active infection are present as this would be considered not medically necessary.

You can use our 2025 updated CTP eligibility checklist to ensure all medical necessity is met and documented: Checklist: https://woundreference.com/files/1559.pdf

Learn more in our 2025 Cellular and Tissue Based Products Topic:

https://woundreference.com/app/topic?id=cellular-andor-tissue-products&find=cellular+and+tissue#documentation-requirements

I hope this helps.

Dec 18, 2024

Marlen Caballero
APRN, AGACNP

Hi Kim - thank you for the information. Are any rules or LCD in place for this year ?

Thank You
Marlen

Dec 19, 2024

Kim Simonson
RN-BC, ACHRN, CWS, FACCWS

Hi Marlen,

Yes,
you can access the regional MAC and LCD coverage criteria in effect until
2/11/2025 under the Cellular and/or Tissue-Based Products topic in
WoundReference here:

https://woundreference.com/app/topic?id=cellular-andor-tissue-products&find=cellular+and+tissue#medicare-administrative-contractors-and-local-coverage-determinations

Dec 19, 2024

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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