Medicare is slashing wound care spending by 90% starting January 2026, putting 10.5 million Americans with chronic wounds at risk of losing access to life-saving treatments. But there’s a critical window of opportunity you need to know about.
Millions of Medicare beneficiaries dealing with chronic wounds may soon face a healthcare crisis. Sweeping changes to Medicare policies are set to dramatically restrict access to advanced wound treatments, leaving patients with diabetic foot ulcers, venous leg ulcers, and pressure sores scrambling for alternatives.
The Centers for Medicare & Medicaid Services (CMS) has announced significant cuts to wound care funding that will take effect January 1, 2026. These changes represent the most substantial reduction in wound care coverage in Medicare's history, with spending on cellular and tissue-based products expected to decrease by nearly 90%.
Under the previous system, Medicare paid for skin substitutes using an average sales price plus 6% model, similar to how biologics are reimbursed. The new rule completely overhauls this approach, reclassifying these life-saving products as "incident to" supplies with severely limited payment structures.
Industry stakeholders including Kenton Gray, CEO Kure Care have expressed concerns about Medicare's decision, calling it a policy that puts 10.5 million Americans at risk. The dramatic funding reduction threatens to create a two-tiered healthcare system where only the wealthy can afford advanced wound treatments.
The new Local Coverage Determination (LCD) for Cellular and Tissue-Based Products (CTPs) implements strict evidence-based practice requirements and standardized clinical thresholds. Coverage will be limited to CTPs with peer-reviewed clinical evidence supporting efficacy in diabetic foot ulcers or venous leg ulcers, potentially leaving numerous effective treatments non-covered.
Diabetic foot ulcers and venous leg ulcers - two of the most common chronic wound types - face significant restrictions under the new policies. These conditions, which often require advanced cellular therapies to heal properly, may no longer qualify for the cutting-edge treatments that have revolutionized wound care in recent years.
The new reimbursement structure caps payments at just $127.28 per square centimeter for skin substitute products. This represents a massive reduction from current payment levels and reflects Medicare's growing concern about the "perceived high costs" of advanced wound treatments.
Medicare officials cite concerns about potential overutilization of expensive therapies as justification for the dramatic cuts. However, wound care specialists argue that these products prevent costly complications like amputations and extended hospital stays.
The financial reality of the new payment structure means many healthcare providers may struggle to afford offering advanced wound treatments. When reimbursements don't cover the cost of providing care, doctors and clinics face difficult choices between financial viability and patient outcomes.
Wound care centers across the country are already evaluating whether they can continue operations under the new payment model. Some facilities may be forced to close specialized wound programs, while others might transition to basic treatments that offer lower healing rates but higher profit margins that cover operating costs.
Among the 10.5 million Americans living with chronic wounds, those suffering from diabetic foot ulcers will face significant coverage limitations under the new restrictions. These wounds, which affect approximately 15% of diabetic patients during their lifetime, often require advanced cellular therapies to prevent limb amputation.
Venous leg ulcers, another common condition among elderly Medicare beneficiaries, also face substantial coverage limitations. These painful, slow-healing wounds can persist for months or years without proper treatment, significantly impacting quality of life and mobility.
Patients who are homebound due to mobility limitations or complex medical conditions face the greatest risk under the new policies. These individuals often rely on mobile wound care services to receive advanced treatments in their homes, but reduced reimbursements may make such services financially unsustainable.
Kure Care specialists are already seeing increased demand from patients seeking to secure treatment plans before the January 2026 changes take effect. The mobile wound care provider emphasizes the importance of establishing care relationships now, while full coverage remains available.
Medicare Part B continues to cover medically necessary wound care services and supplies through the end of 2025. This includes coverage for chronic wounds like diabetic ulcers, venous leg ulcers, and pressure sores when deemed medically necessary by a physician.
Current coverage includes advanced wound dressings, debridement procedures, and cellular tissue products that meet Medicare's clinical criteria. Patients should work with their healthcare providers now to maximize the benefits of existing coverage before the restrictions take effect.
Medicare Part A covers inpatient wound care services, including hospitalization for wound complications and care provided in skilled nursing facilities. This coverage remains intact under current policies, providing a safety net for patients with severe wound complications.
Skilled nursing facility care for wound management continues to be covered when patients require daily wound care that cannot be safely provided at home. However, the reduced availability of advanced outpatient treatments may lead to more patients requiring costly inpatient interventions.
Medicare continues to cover Hyperbaric Oxygen Therapy (HBOT) for specific chronic wounds, especially diabetic foot ulcers that meet clinical criteria including Wagner grade III or higher classification and failure of standard wound therapy. This specialized treatment increases oxygen levels in wound tissues, promoting healing in cases where traditional therapies have failed.
HBOT coverage requires strict documentation of wound progression and failure of standard treatments. Patients must meet specific criteria, including wound duration and depth requirements, to qualify for this expensive but effective therapy.
Mobile wound care services are becoming increasingly important as traditional clinic-based care faces reimbursement challenges. These programs bring advanced wound technologies directly to patients' homes, eliminating transportation barriers and reducing infection risks.
Advanced human cell and tissue allografts, biologically enhanced collagen treatments, and gentle debridement technologies can all be delivered in home settings by trained specialists. This approach ensures patients maintain access to cutting-edge treatments regardless of mobility limitations or geographic location.
Mobile wound care programs excel at reducing hospital readmissions through coordinated care management. Pre-discharge planning, customized communication with healthcare teams, and ongoing follow-up care prevent wound complications that often lead to emergency room visits.
Patient and family education delivered in the home setting reinforces wound care best practices and helps prevent setbacks. This coordinated approach has proven effective at improving healing outcomes while reducing overall healthcare costs.
Time is running out for Medicare beneficiaries to secure access to wound care services under current coverage. With approximately one year remaining before the new restrictions take effect, patients with chronic wounds should act immediately to establish care relationships and treatment plans.
Healthcare providers are urging patients to schedule wound assessments now, while full coverage remains available. Early intervention with advanced therapies can promote faster healing and prevent the need for more invasive treatments later.
The window for accessing advanced wound treatments under current Medicare coverage is rapidly closing. Patients should work with specialized wound care providers to develop treatment strategies that maximize healing potential before the January 2026 restrictions take effect.
Contact Kure Care today to learn how your mobile wound care specialists can deliver advanced treatment technologies directly to your home while Medicare coverage is still available.
