Skin and Soft Tissue Substitute Policy and Prior Authorization Updates

Date: 06/25/25

Ambetter from PA Health & Wellness is notifying providers of an update to the policy regarding prior authorizations of Skin and Soft Tissue Substitutes for Ambetter Health members.

Effective August 1, 2025, Clinical Policy: Skin and Soft Tissue Substitutes for Chronic Wounds (CP.MP.185) will require all codes listed within to be reviewed for prior authorization. This policy outlines the review process and clinical rationale for using various types of substitutes available within the healthcare services market.

For the complete Skin and Soft Tissue Substitute Policy, please visit Ambetter Health’s Clinical policy page.

All policies and procedures are regularly reviewed as part of our commitment to delivering quality, cost-effective care for Ambetter Health members. Please contact your health plans provider engagement team for additional information and questions related to this policy update.

Thank you for your partnership and commitment to improving the health of our communities, one person at a time.