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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
Days to comply

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

Action needed
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.

Affected Billing Codes

A2001
A2002
A2004
A2005
A2006
A2007
A2008
A2009
A2010
A2011
A2012
A2013
A2014
A2015
A2016
A2017
A2018
A2019
A2020
A2021
A2022
A2023
A2024
A2025
A2026
A2027
A2028
A2029
A2030
A2031
A2032
A2033
A2034
A2035
A2036
A2037
A2038
A2039
A4100
C9354
C9358
C9360
C9361
C9363
C9364
Q4100
Q4101
Q4102
Q4103
Q4104
Q4105
Q4107
Q4108
Q4110
Q4111
Q4112
Q4113
Q4114
Q4115
Q4116
Q4117
Q4118
Q4121
Q4122
Q4123
Q4124
Q4125
Q4126
Q4127
Q4128
Q4130
Q4132
Q4133
Q4134
Q4135
Q4136