Podiatric Medical News
The Voice of Podiatrists
Serving Over 20,000 Subscribers Daily
January 15, 2026 #8,184
Publisher-Barry Block, DPM, JD
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- Discarded Skin Substitutes Will Not Be Paid. Medicare does not reimburse for any unused or discarded portions of non-BLA skin substitutes, regardless of package size or clinical necessity.
- JW and JZ Modifiers Do Not Apply. The JW and JZ modifiers are limited to drugs and biologicals payable under Medicare Part B and must not be used for skin substitutes billed as incident-to supplies.
- Only the Applied Portion Is Billable. Providers may bill Medicare only for the units actually administered to the patient; discarded units must be absorbed by the provider, making waste reduction and product selection more important than ever.
- Denials and Underpayments: Coding errors are responsible for up to 22% of claim denials in private practices, frequently due to mismatched codes, lack of medical necessity, or payer-specific requirements.
- Delayed Reimbursements: Incorrect coding leads to delayed payments, which increases days in A/R—contributing to the creeping percentage of aged receivables over 90 days—disrupting cash flow and forcing staff time to be diverted from core responsibilities to re-working claims and managing denials.
- Lost Revenue: Industry estimates suggest that 10-20% of claims are denied on first submission, many of which could be avoided with proper coding.
- Compliance Risks: Mistakes like upcoding or unbundling can trigger audits, fines, and even fraud allegations. Penalties under the False Claims Act can reach $27,000 per claim, plus triple damages.
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