MedicaidCoverageHigh impact
Skin and Tissue Substitutes - MEDICAID - LOUISIANA (New)
Humana·LA · Wound Care, Plastic Surgery, General Surgery +2 more·Medicaid
Effective date
Nov 12, 2025
We identified it
Jun 24, 2026
Summary
Humana Louisiana Medicaid has established a new coverage policy for skin and tissue substitutes (cellular and tissue-based products). The policy defines specific coverage criteria for 12 different skin substitute products including Apligraf, Dermagraft, and Integra products, primarily for treating diabetic foot ulcers, venous leg ulcers, and burn wounds that meet specific duration and severity requirements.
Action Required
Before November 12, 2025: Billing team must update Louisiana Medicaid billing protocols to ensure skin and tissue substitute claims meet the specific coverage criteria outlined in policy LA.CLI.083. Verify that documentation supports ulcer duration >4 weeks, failure of standard wound therapy, and no bone/muscle/tendon exposure for wound care products. Update billing system with the 12 covered HCPCS codes and their specific indications. Train providers on documentation requirements as claims not meeting these criteria will be denied.