MedicaidCoverageHigh impact
Skin and Tissue Substitutes - MEDICAID - VIRGINIA (Revised)
Humana·VA · Wound Care, Podiatry, Plastic Surgery +2 more·Medicaid
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid Virginia has updated coverage criteria for skin and tissue substitutes, limiting coverage to only diabetic foot ulcers and chronic venous leg ulcers (both >4 weeks duration) when used with comprehensive standard wound therapy. All other indications are considered not medically necessary.
Action Required
By January 1, 2025: Billing team must update prior authorization and documentation requirements for all skin and tissue substitute codes when billing Virginia Medicaid. Ensure documentation includes diabetes diagnosis for DFU or venous insufficiency for VLU, wound duration >4 weeks, comprehensive wound care plan, and no exposed bone/capsule/tendon. Claims for other indications will be denied as not medically necessary.