Why The MAC Matters
Original Medicare claims are processed by Medicare Administrative Contractors (MACs), each responsible for a group of states. Where no national coverage determination exists, the MAC writes a local coverage determination (LCD) and a companion billing and coding article. Skin substitutes for chronic wounds fall in that category, so coverage is local.
The jurisdiction is set by where the service is furnished, not where the practice's billing office sits. A group with clinics in two jurisdictions works under two sets of rules.
The Part B MAC Jurisdictions
CMS currently contracts with four companies across twelve A/B MAC jurisdictions. Contract awards change over time, so confirm the current assignment on the CMS MAC page before relying on this list.
- Noridian Healthcare Solutions: Jurisdictions E and F (western states, Alaska and Hawaii)
- Wisconsin Physicians Service: Jurisdictions 5 and 8 (Midwest)
- National Government Services: Jurisdictions 6 and K (upper Midwest, New York and New England)
- CGS Administrators: Jurisdiction 15 (Kentucky and Ohio)
- Novitas Solutions: Jurisdictions H and L (south central and mid-Atlantic states)
- Palmetto GBA: Jurisdictions J and M (southeast and the Carolinas and Virginias)
- First Coast Service Options: Jurisdiction N (Florida, Puerto Rico and the U.S. Virgin Islands)
What An LCD Typically Controls
Wound care LCDs differ in detail, but the same elements decide most claims. Reading the policy for the location of service before the first application is the single most effective way to prevent denials.
- Covered wound types and diagnoses, most often diabetic foot ulcers and venous leg ulcers
- The period of documented standard care required before the first application
- Products the contractor lists as covered or non-covered
- The number of applications allowed in an episode and what supports additional applications
- Required diagnosis code pairings and modifiers in the billing and coding article
The 2026 Harmonized LCDs Were Withdrawn
Several MACs had finalized matching LCDs for skin substitutes on diabetic foot ulcers and venous leg ulcers, scheduled to take effect January 1, 2026. CMS announced on December 24, 2025 that those final LCDs were withdrawn. The payment changes in the 2026 Physician Fee Schedule went forward on their own, and coverage continues to be governed by the policies each MAC has in effect.
Because the policy landscape is still moving, the current LCD and billing article in the Medicare Coverage Database should be checked at the start of each episode of care, not just once a year.
Prior Authorization In Some States
Starting in 2026, CMS's WISeR model added prior authorization or pre-payment review for selected services, including skin and tissue substitutes, in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. Practices in those states should confirm whether the service requires a request before treatment.
Frequently Asked Questions
- How do I find the skin substitute LCD that applies to my practice?
- Search the CMS Medicare Coverage Database by the state where the service is performed and filter for local coverage. Read both the LCD and its billing and coding article, since the coding rules are usually in the article.
- Do Medicare Advantage plans follow the MAC's LCD?
- Medicare Advantage plans must follow traditional Medicare coverage criteria, including applicable LCDs, but they also apply their own prior authorization and claims rules. Check the plan's requirements in addition to the LCD.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.