MedicaidCoverageMedium impact
Skin and Tissue Substitutes - MEDICAID - FLORIDA (Revised)
Humana·FL · Wound Care, Podiatry, Endocrinology +2 more·Medicaid
Effective date
Jun 22, 2026
We identified it
Jun 24, 2026
Summary
New Florida Medicaid policy establishes coverage criteria for skin and tissue substitutes for diabetic foot ulcers and chronic venous leg ulcers. Coverage requires strict adherence to comprehensive wound care protocols and is limited to ulcers over 4 weeks duration without exposed bone, capsule, or tendon.
Action Required
Before June 22, 2026: Billing team must update Florida Medicaid prior authorization requirements for HCPCS codes Q4101-Q4279 skin substitutes. Verify all criteria are met: ulcer duration >4 weeks, no exposed bone/tendon, appropriate offloading, compression therapy for venous ulcers, infection treatment, and optimal glycemic control. Update encounter forms to ensure providers document all required elements. Claims without meeting ALL criteria will be denied.