# 119-hr-5768: Skin Substitute Access and Payment Reform Act

119-hr-5768, Skin Substitute Access and Payment Reform Act, is a 119th Congress bill sponsored by Rep. Carter, Earl L. "Buddy" [R-GA-1] (R-GA); status introduced; PRIA reads it as touching household money (as of 2026-10-31).

- Canonical: https://policyrisk.com/legislation/119-hr-5768
- As of: 2026-10-31
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-5768
- Congress: 119
- Title: Skin Substitute Access and Payment Reform Act
- Status: introduced
- Introduced: 2025-10-17
- Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] (R-GA)
- Cosponsors: 8
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2026-10-31

## Summary

**Would create a federal Medicare framework to define, cover, and pay for skin substitute products.** It would set a new payment method, require a single billing code, and add integrity controls like prepayment review and prior authorization for identified outlier providers. - Medicare patients with wounds: These products would be explicitly covered when they meet the bill's definition as cellular, tissue, biological, or synthetic materials used on wounds. Temporary dressings and liquid, gel, or powder items are excluded. - Providers: A two-part payment system would apply to shipments furnished on or after Jan 1, 2026, with payment capped at 80 percent of the lesser of the actual charge or the new payment amount, and a consolidated billing code must be established by Jan 1, 2026. - Manufacturers and program oversight: Skin substitute products would be excluded from drug/biologic reporting rules beginning Jan 1, 2026. The payment rate would be tied to a volume-weighted price from the October 2023 ASP pricing file with CPI-based updates starting in 2027, and the Centers for Medicare & Medicaid Services would get authority and funding for prepayment reviews, prior authorization for outliers, and enrollment revocation or exclusion for noncompliance.

## Cosponsors (8)

- Rep. Veasey, Marc A. [D-TX-33] (D-TX), 2025-10-17T00:00:00.000Z
- Rep. Steube, W. Gregory [R-FL-17] (R-FL), 2025-10-17T00:00:00.000Z
- Rep. McCormick, Richard [R-GA-7] (R-GA), 2025-10-17T00:00:00.000Z
- Rep. Lee, Susie [D-NV-3] (D-NV), 2026-10-29T00:00:00.000Z
- Rep. Hunt, Wesley [R-TX-38] (R-TX), 2025-10-28T00:00:00.000Z
- Rep. Vindman, Eugene Simon [D-VA-7] (D-VA), 2025-10-28T00:00:00.000Z
- Rep. Ciscomani, Juan [R-AZ-6] (R-AZ), 2025-11-25T00:00:00.000Z
- Rep. Bice, Stephanie I. [R-OK-5] (R-OK), 2025-12-26T00:00:00.000Z

## Provisions PRIA read

- Medicare coverage rules for skin substitutes: benefit, medium. If enacted, Medicare would add skin substitute products to items it can cover. The bill would define which products count: used on a wound, meant to stay in the wound, and marketed under certain FDA paths. It would exclude temporary dressings and products that are liquids, gels, or powders. For car…
- Simpler billing for skin substitute products: benefit, low. If enacted, HHS would create one billing and payment code for all skin substitute products by January 1, 2026. Starting January 1, 2026, these products would not be treated as drugs or biologics for certain Medicare reporting rules. This could make claims simpler and reduce some reporting steps. It…
- New checks on high-use Medicare skin substitute providers: mixed, medium. By December 1, 2025, and every two years through 2035, CMS would name the top 3% of providers with the highest total Medicare payments for skin substitutes. On January 1, 2026, CMS would start prepayment claim review for those outliers unless certain safeguards are met. Prior authorization for thos…
- New Medicare payment and 20% coinsurance for skin substitutes: mixed, medium. Starting January 1, 2026, Medicare would set one payment amount for skin substitutes. The 2026 amount would be a weighted average based on October 2023 prices and 2023 billed units. Each year after 2026, it would update by CPI-U for the 12 months ending in June of the prior year. Medicare would pay…

## Related bills

- 119-hr-909: Crime Victims Fund Stabilization Act of 2025
- 119-hr-452: Miracle on Ice Congressional Gold Medal Act
- 119-hr-1262: Mikaela Naylon Give Kids a Chance Act
- 119-hr-842: Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act
- 119-hr-1422: Enhanced Iran Sanctions Act of 2025
- 119-hr-9250: Great American Outdoors Act 250

## Sources
- [119-hr-5768 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/5768)

## Related
- [119-hr-909: Crime Victims Fund Stabilization Act of 2025](https://policyrisk.com/legislation/119-hr-909)
- [119-hr-452: Miracle on Ice Congressional Gold Medal Act](https://policyrisk.com/legislation/119-hr-452)
- [119-hr-1262: Mikaela Naylon Give Kids a Chance Act](https://policyrisk.com/legislation/119-hr-1262)
- [119-hr-842: Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage A…](https://policyrisk.com/legislation/119-hr-842)
- [119-hr-1422: Enhanced Iran Sanctions Act of 2025](https://policyrisk.com/legislation/119-hr-1422)
- [119-hr-9250: Great American Outdoors Act 250](https://policyrisk.com/legislation/119-hr-9250)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-5768 (as of 2026-10-31).