MedicaidCoverageMedium impact
District of Columbia Medicaid: Coverage criteria for skin and soft tissue substitutes
UnitedHealthcare·DC · Plastic Surgery, General Surgery, Wound Care +2 more·State news
Effective date
Dec 1, 2025
We identified it
Jan 12, 2026
Summary
UnitedHealthcare Community Plan of District of Columbia will begin reviewing medical claims for skin and soft tissue substitutes against new coverage criteria. Claims that don't meet the outlined criteria or lack required documentation will be denied.
Action Required
By December 1, 2025: Billing team must review the new Skin and Soft Tissue Substitutes Medical Policy for DC Medicaid members and ensure all claims include required documentation per coverage criteria. Access the full policy through the UnitedHealthcare Provider Portal to understand specific requirements. Claims not meeting criteria or missing requested records will be denied.