Medicare’s January 2026 changes will force patients to wait four weeks before accessing advanced wound treatments. The cuts are a balancing game – spending on these therapies has jumped from $252 million to over $10 billion – but delays can lead to amputation.
Medicare beneficiaries with chronic wounds face a critical decision as sweeping policy changes approach. Beginning January 1, 2026, the Centers for Medicare & Medicaid Services will implement new Local Coverage Determinations requiring patients to complete four-week standard care trials before accessing advanced wound therapies. These changes represent the most significant shift in wound care coverage in decades, affecting millions of Americans with non-healing wounds, according to the wound care experts and CEO Kenton Gray at KureCare.
The upcoming Medicare policy overhaul stems from dramatic spending increases in wound care treatments. Part B spending for skin substitute products alone jumped from roughly $252 million in 2019 to over $10 billion in 2024, prompting CMS to implement stricter coverage requirements. Starting in January 2026, patients must demonstrate that standard wound care approaches have failed before qualifying for advanced therapies like skin substitutes, cellular treatments, or negative pressure wound therapy.
Under the new Local Coverage Determinations, wounds must show at least 50% reduction in ulcer area during the mandatory four-week trial period. This requirement applies to all FDA-approved skin substitute products, which will receive flat-rate reimbursement at $127.28 per square centimeter regardless of their regulatory pathway. The policy aims to encourage cost-effective treatment approaches while reducing Medicare's financial exposure to expensive biologics and advanced wound care technologies. However, the change increases patients' risk exposure in other ways.
Medical research demonstrates that timing plays a crucial role in wound healing outcomes. Delaying wound treatment can increase the risk of complications like infection, impaired healing, chronic pain, and can lead to amputation. This statistic becomes particularly concerning for Medicare beneficiaries with diabetes, compromised immune systems, or circulation problems that already complicate wound healing processes and KureCare is extremely concerned about what this can mean for their patients and others with non-healing wounds.
The four-week mandatory trial period under new Medicare rules may seem reasonable from a cost-containment perspective, but it introduces significant clinical risks. During this waiting period, chronic wounds continue to provide pathways for bacterial entry, increasing the likelihood of infection. Delays can transform manageable conditions into limb-threatening emergencies requiring hospitalization or surgical intervention.
For diabetic patients, these risks become particularly acute due to compromised circulation and reduced immune response capabilities. The progression from chronic wound to limb loss often follows a predictable pattern. Initial tissue damage fails to heal properly, creating conditions favorable for bacterial growth. Without appropriate intervention, superficial infections can spread to deeper tissues, bones, and eventually the bloodstream. Advanced wound care technologies currently available under Medicare Part B coverage can interrupt this dangerous progression, but access to these treatments will become more restricted in January 2026.
The financial burden of wound care extends far beyond initial treatment costs. Studies show that the annual cost of treating chronic wounds for Medicare beneficiaries ranges from $28 billion to $32 billion. These figures include not only direct treatment expenses, but also complications, hospitalizations, and long-term care requirements that result from delayed or inadequate wound management.
While the changes are meant to interrupt current skyrocketing spending patterns, it's difficult to tell whether the new requirements will reduce costs considerably. Restricting access to advanced therapies may trigger other cost increases if patients develop complications requiring more expensive interventions like surgical debridement, amputation procedures, or extended hospitalization stays.
Medicare Part B currently provides coverage for medically necessary wound care services and supplies for both acute injuries and chronic, stubborn wounds. This coverage includes essential services like wound debridement, specialized dressing changes, and monitoring visits with wound care specialists. Patients can access these services through outpatient clinics, physician offices, and certified wound care centers without completing mandatory trial periods.
The current coverage framework also includes durable medical equipment essential for wound healing. Negative Pressure Wound Therapy devices, compression garments, and specialized wound irrigation systems remain covered under existing Medicare Part B provisions. These treatments have proven effectiveness in accelerating healing processes and preventing complications that could require more expensive interventions.
Under current Medicare rules, patients with qualifying chronic wounds can access advanced therapies immediately upon clinical assessment. Skin substitute products, cellular therapies, and bioengineered tissue constructs remain available for appropriate candidates without mandatory waiting periods. This immediate access allows wound care specialists to implement aggressive treatment approaches when clinical indicators suggest standard care approaches may prove insufficient.
However, the window for accessing these advanced treatments under current coverage rules closes on December 31, 2025. After that date, patients must complete the mentioned four-week standard care trials and demonstrate 50 percent wound area reduction before qualifying for advanced therapy coverage. The timeline is urgent for patients with existing chronic wounds to seek evaluation and initiate treatment now. Kenton Gray and the entire KureCare team urge you to seek treatment now.
