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Effective for dates of service on or after January 1, 2027, the Health Care Authority (HCA) is aligning its skin substitutes policy across professional and outpatient hospital settings, including critical access and rural emergency hospitals. The following skin substitutes will remain covered in these settings:
Q4101 Apligraf, per 1 sq cm Q4102 OASIS Wound Matrix, per 1 sq cm Q4128 FlexHD / AllopatchHD, per 1 sq cm Q4132 Grafix Core, per 1 sq cm Q4133 Grafix PRIME / Stravix PRIME, per 1 sq cm Q4186 EpiFix, per 1 sq cm
Coverage for all other skin substitutes in outpatient hospital settings will be discontinued for dates of service on and after January 1, 2027. To prevent denial of claims, see the Physician-Related Services/Health Care Professional Services Billing Guide.
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