Guide · Updated 2026-06-28
MAC Jurisdiction Coverage Variance for Skin Substitutes
There are seven MAC jurisdictions, each with its own LCD on skin substitutes. Frequency limits, covered indications, and documentation requirements vary materially. Multi-state systems need a MAC-aware formulary, not a national one.
The seven MAC jurisdictions
Noridian (JE/JF), Palmetto GBA (JJ/JM), CGS (J15), NGS (J6/JK), Novitas (JH/JL), WPS (J5/J8), and First Coast (JN) each publish their own skin substitute LCDs. Coverage policy and frequency limits diverge meaningfully.
Frequency limit variance
Most MAC LCDs cap covered applications per episode (commonly 5–10). Caps vary by product and indication. Multi-state systems should map per-MAC frequency limits per product before standardizing protocols.
Documentation requirements
All MACs require documentation of: failed conservative care (typically 4 weeks), wound measurements at each visit, debridement performance, and offloading/compression. Audit-worthy documentation is the single biggest determinant of clean claim rates.
Procurement implication
Formulary primary product selection should align with the dominant MAC jurisdictions in your system's footprint. A product widely covered in JH may face restrictive frequency limits in JE.
Key takeaways
- Seven MACs, seven LCDs — coverage is not national.
- Map frequency limits per product per MAC.
- Documentation is the #1 determinant of clean claims.
- Align formulary to your dominant MAC footprint.
More from the playbook
Part of the 2026 Advanced Wound Graft Procurement Playbook.