Cost Modeling of Placenta-Derived Skin Substitutes Versus Second-Intention Healing for Post-Mohs Defects: A Pricing Inquiry and Scenario Analysis

Cost Modeling of Placenta-Derived Skin Substitutes Versus Second-Intention Healing for Post-Mohs Defects: A Pricing Inquiry and Scenario Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cost Modeling of Placenta-Derived Skin Substitutes Versus Second-Intention Healing for Post-Mohs Defects: A Pricing Inquiry and Scenario Analysis Mustufa Jafry, William Hanke This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8752523/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Placenta-derived skin substitutes are marketed for post-Mohs wounds, but financial impact is uncertain. Objective: To estimate practice acquisition costs and modeled Medicare product reimbursement for placenta-derived products versus second-intention (SI) healing in two post-Mohs defects. Methods: In 2025, vendors provided pricing and coding inputs. We modeled (A) a 4×4 cm forehead defect to temporalis fascia (16 cm²) treated weekly for 4 applications and (B) a 4×3.5 cm medial foot defect to deep subcutaneous fat (14 cm²) treated weekly for 6 applications, using the smallest sheet with ≤10% waste. SI was modeled as supply-only clinic costs during the postoperative global period. Results: For a 16 cm² defect, per-application acquisition ranged from $1,495 (MiMedx EpiFix 4×4.5 cm) to $35,031 (Samaritan Biologics Complete AA); modeled Medicare product reimbursement ranged from $1,668 to $43,115 per application. Cumulative acquisition was $5,980–$140,125 (forehead) and $8,970–$210,187 (foot) versus SI $120–$320 and $180–$480. Limitations: Inputs were company-reported; regional/contract variability was not assessed; closure times were modeled; SI excluded patient-reported outcomes and opportunity costs. Conclusions : Even moderate post-Mohs defects can generate large cumulative expenditures with placental substitutes. Pre-use cost modeling, accurate coding, waste minimization, and documentation of medical necessity should precede routine use. Figures Figure 1 Figure 2 Capsule summary • What is known: Placenta-derived skin substitutes are increasingly used after Mohs surgery, but costs and reimbursements are highly variable. • What this adds: In modeled 14–16 cm² defects, cumulative product acquisition reached ~$6k–$210k versus <$500 for SI healing, supporting pre-use cost modeling, waste control, and necessity documentation. Introduction Placenta-derived skin substitutes, including dehydrated amnion/chorion membranes, hypothermically stored matrices, and multi-layer constructs, are increasingly incorporated into the management of complex cutaneous wounds and select post-Mohs defects where primary closure, flaps, or full-thickness grafts are suboptimal 1 – 2 .However, the financial implications for dermatologic practices and Medicare are opaque, with wide variation in acquisition price, billable units, product-specific HCPCS codes, and maximum units of service (MUEs) 3 . Although several cost-effectiveness analyses have examined amniotic products in chronic ulcers, few studies address the real-world costs of placenta-derived grafts specifically in post-Mohs surgery, where the postoperative global period limits billable visits, moderate-sized defects may be amenable to SI, and products are often applied serially. Understanding these costs is essential as new Q-codes and high-priced matrices continue to enter the market. We therefore performed a standardized pricing inquiry and scenario-based cost model using two representative post-Mohs defects to quantify practice-side spend and modeled Medicare reimbursements and compare these values to SI healing. Methods Pricing Inquiry In 2025, we sent a structured email requesting (1) practice acquisition costs, (2) recommended graft sizes and application frequency, (3) HCPCS codes and per-unit Medicare amounts (if available), (4) CPT application codes by anatomic class, (5) 1 × 1 cm pricing, and (6) operational details (MUEs, consignment, waste rules, POS). Companies providing responses included Samaritan Biologics, MiMedx, Organogenesis, and ConvaTec (InnovaMatrix AC). Responses are quoted numerically in Tables 1 –3 (verbatim values preserved when provided, including quarterly Medicare amounts and MUEs). Clinical Scenarios Scenario A (Forehead) : 4 × 4 cm post-Mohs defect to temporalis fascia (16 cm²). Application CPT category: face/scalp class. Scenario B (Medial Foot) : 4 × 3.5 cm post-Mohs defect to deep subcutaneous fat (14 cm²). Application CPT category: feet class. Figure 1. Representative post-Mohs defect scenarios used for cost modeling. (A) Forehead defect measuring 4 × 4 cm (16 cm²) with depth to temporalis fascia; modeled as the face/scalp anatomic class for application coding. (B) Medial foot defect measuring 4 × 3.5 cm (14 cm²) with depth to deep subcutaneous fat; modeled as the feet anatomic class for application coding. These standardized scenarios served as inputs for weekly placenta-derived skin substitute application modeling and comparison with second-intention (SI) healing. Base-case closure horizon weekly applications; forehead closes in 4 weeks ; foot in 6 weeks . Where vendors supplied medians (multi-center analysis ~ 5 weeks overall), we aligned base-case horizons accordingly and tested 1–10 applications in sensitivity analysis. Coding & Site of Service Application CPT (physician office): 15275 (face, scalp, hands, feet, etc.), first 25 cm² (or less); 15271 (trunk, arms, legs), first 25 cm² (or less); add-on codes per 25 cm²/100 cm² as applicable. Companies reported HCPCS product codes and per-unit Medicare amounts (varied by quarter and MAC); we used the submitted unit amounts as given. Samaritan Biologics noted Medicare eligibility and POS criteria (POS 11/32) and a 35% Volume Discount (VD) off list with weekly applications allowed up to 10 in 12 weeks, subject to IVR. We model physician-office setting (POS 11). SI (Second-Intention) Cost Model We assumed SI follow-ups fall under the post-operative global with no separately billable E/M , using supply-only clinic costs: non-adherent contact layer, secondary dressing, tape, and nurse change time $20–$40/visit . Forehead (4 visits): $80–$160 plus initial bulky dressing ( $40–$160 ), total SI $120–$320 . Foot (6 visits): $120–$240 plus initial ( $60–$240 ), total SI $180–$480 . These conservative ranges intentionally favor the skin-substitute arm in comparative costing. Calculations For each product, we selected the smallest size covering the wound area while minimizing waste per vendor guidance (≤ 10% when possible). We multiplied acquisition cost per application by the number of applications (4 for forehead, 6 for foot). For modeled Medicare product reimbursement, we used vendor-reported HCPCS/unit values and units (or area) per application, adding the appropriate base application CPT amount per application ( 15275 for both scenarios) from the materials provided. Where a vendor’s example CPT conflicted with standard descriptors (e.g., 15271 used for a forehead wound), we corrected to 15275 for face/scalp/feet per the descriptors supplied in the Organogenesis billing guide. Results Table 1 Vendor-Reported Pricing & Coding Company Product Size(s) modeled HCPCS Units/MUE Acquisition price (per app) Vendor-reported Medicare per-unit Notes MiMedx EpiFix (mesh) 4×4.5 cm (18 cm²) (Q-code not provided in email; EpiFix commonly Q41xx) 11 BU (per vendor) $1,495 (or $ 1,405/10-pack) $1,668.15/app (vendor total) 24 mm disk (5 BU) too small for 14–16 cm² defects MiMedx Epicord 3×5 cm (15 cm²) (—) 15 BU $3,535 $3,679.50/app HA-containing option emphasized for cosmesis MiMedx Epixpress (3-layer) 3×5 cm (—) 15 BU $22,500 $31,500/app High-end, fenestrated; large budget impact Organogenesis Cygnus Dual 4×4 cm (16 cm²) 04282 16 units/app $5,300 $487.31/cm² (~ $ 7,796.96/app) Vendor lists CPT schedules and multiple products Organogenesis Via Matrix 4×4 cm (16 cm²) 04309 16 units/app $13,870 $1,323.96/cm² (~ $ 21,183.36/app) – Organogenesis Affinity 2.5×2.5 cm; need 3 for 16 cm² 04159 19 BU/app $3,825/app (3× $ 1,275) $262.92/cm² (~ $ 4,995.48/app via 19 BU) Vendor states 3 sheets for 4×4 cm ConvaTec InnovaMatrix AC 4×4 cm (16 cm²) A2001 16 units/app $10,944 (net @ 40% discount) $1,174.20/cm² (~ $ 18,787.20/app, WPS) Shelf-stable; consignment available Samaritan Biologics Complete AA Sheet sized to area (16 cm²) Q4303 MUE 300 $35,031/app (35% VD off $ 3,368.39/cm²) 80% of list (~ $ 43,115/app) Weekly apps up to 10 in 12 weeks w/ IVR; POS 11/32 Samaritan Biologics MLG Complete Area-matched Q4256 MUE 300 $7,644/app (35% VD off $ 735.04/cm²) 80% of list (~ $ 9,409/app) – CPT application (office) 15275 face/scalp/feet , 15271 trunk/arms/legs. Table 2 Modeled Cumulative Costs by Scenario (Base-Case Applications) Assumptions : Forehead 4 apps (weekly ×4); Foot 6 apps (weekly ×6); CPT per application 15275 = $153.99 (from vendor billing guide). Where vendors supplied an “app-total reimbursement,” we added CPT only when not already included. Product (size) Per-app acquisition Per-app modeled reimbursement (product only) Forehead 4 apps: cumulative acquisition Forehead modeled reimbursement (product only + CPT) Foot 6 apps: cumulative acquisition Foot modeled reimbursement (product only + CPT) MiMedx EpiFix 4×4.5 $ 1,495 $ 1,668/app $5,980 ~ $ 6,672 + $ 615.96 = $7,287.96 $8,970 ~ $ 10,008.9 + $ 923.94 = $10,932.84 MiMedx Epicord 3×5 $ 3,535 $ 3,679.5/app $14,140 ~ $ 14,718 + $ 615.96 = $15,333.96 $21,210 ~ $ 22,077 + $ 923.94 = $23,000.94 MiMedx Epixpress 3×5 $ 22,500 $ 31,500/app $90,000 ~ $ 126,000 + $ 615.96 = $126,615.96 $135,000 ~ $ 189,000 + $ 923.94 = $189,923.94 Org. Cygnus Dual 4×4 $ 5,300 ~ $ 7,796.96/app $21,200 ~ $ 31,187.84 + $ 615.96 = $31,803.80 $31,800 ~ $ 46,781.76 + $ 923.94 = $47,705.70 Org. Via Matrix 4×4 $ 13,870 ~ $ 21,183.36/app $55,480 ~ $ 84,733.44 + $ 615.96 = $85,349.40 $83,220 ~ $ 127,100.16 + $ 923.94 = $128,024.10 Org. Affinity (3× 2.5×2.5) $ 3,825 ~ $ 4,995.48/app $15,300 ~ $ 19,981.92 + $ 615.96 = $20,597.88 $22,950 ~ $ 29,972.88 + $ 923.94 = $30,896.82 ConvaTec InnovaMatrix AC 4×4 $ 10,944 ~ $ 18,787.20/app $43,776 ~ $ 75,148.80 + $ 615.96 = $75,764.76 $65,664 ~ $ 112,723.20 + $ 923.94 = $113,647.14 Samaritan Complete AA ~ $ 35,031 ~ $ 43,115/app $140,125 ~ $ 172,460 + $ 615.96 = $173,075.96 $210,187 ~ $ 258,690 + $ 923.94 = $259,613.94 Samaritan MLG Complete ~ $ 7,644 ~ $ 9,409/app $30,576 ~ $ 37,636 + $ 615.96 = $38,251.96 $45,864 ~ $ 56,454 + $ 923.94 = $57,377.94 Second-Intention (SI) supply-only clinic costs Forehead $120–$320 total; Foot $180–$480 total (see Methods). Key findings: Lowest-cost option: MiMedx EpiFix 4×4.5 cm ( $ 1,495/application). Highest-cost option: Samaritan Biologics Complete AA ( $ 35,031/application after discount). Forehead defect: Cumulative practice spend ranged $ 5,980– $ 140,125, compared with SI $ 120– $ 320. Foot defect: Cumulative spend ranged $ 8,970– $ 210,187, compared with SI $ 180– $ 480. Modeled Medicare reimbursements outpaced acquisition costs in most products but yielded large absolute payer expenditures. Figure 1 Cumulative acquisition cost vs number of applications (1–10) for representative products (EpiFix 4×4.5, Cygnus Dual 4×4, InnovaMatrix AC 4×4). Sensitivity Analysis Applications : Costs scale linearly with number of applications. Even low-cost sheets (e.g., EpiFix 4×4.5) exceed SI supply costs by 1–2 applications. Sheet sizing & waste : Switching from a 4×4 sheet to 3× 2.5×2.5 (Affinity) reduced per-app acquisition by ~ $ 1,475 in the 16 cm² defect while maintaining reimbursement, highlighting the financial impact of waste minimization. MAC/quarter variability : Products with A-/Q-codes priced “per cm²” (e.g., InnovaMatrix AC, Cygnus Dual, Via Matrix) produced large swings in modeled reimbursement; quarterly updates can materially alter margins. Discounting/consignment : ConvaTec’s net pricing (40% off list in the materials provided) and Samaritan’s 35% Volume Discount substantially lowered practice acquisition but did not eliminate large cumulative spend. Cumulative acquisition cost is plotted against the number of weekly applications for representative products spanning lower-, mid-, and higher-cost categories: MiMedx EpiFix (4 × 4.5 cm), Organogenesis Cygnus Dual (4 × 4 cm), and ConvaTec InnovaMatrix AC (4 × 4 cm). For each product, the modeled sheet size was the smallest that covered a 14–16 cm² defect while targeting ≤ 10% waste when feasible. Costs increase linearly with additional applications, illustrating the rapid escalation in total expenditure with serial use in moderate-sized post-Mohs defects Discussion This pricing inquiry demonstrates that placenta-derived skin substitutes can generate substantial cumulative costs in common post-Mohs scenarios, with orders-of-magnitude variation across brands. For moderate defects (14–16 cm²), per-application acquisition ranged from ~ $ 1.5k to > $ 35k, and a typical 4–6-application course produced total practice spend from $ 6k to over $ 200k. While modeled Medicare product reimbursements often outstrip acquisition (creating a positive spread), the absolute payer outlay is high. These findings align with clinicians’ anecdotal observations that biologic dressings can become expensive quickly when used serially. Clinical considerations. Our analysis does not argue for or against clinical efficacy in specific Mohs scenarios; rather, it highlights the need to reserve placenta-derived products for carefully selected defects with clear medical necessity (e.g., exposed critical structures, compromised vascularity, or patients unable to tolerate secondary procedures) 4 – 5 . Incorporating cost modeling into shared decision-making may help identify patients who derive disproportionate benefit relative to expense. Documentation & compliance. Several respondents stressed POS eligibility, IVR, and MUE rules. We observed a coding inconsistency in one response (forehead coded as 15271); per descriptors supplied in another vendor’s billing guide, 15275 applies to face/scalp/feet and 15271 to trunk/arms/legs. Accurate coding, maintenance of waste ≤ 10%, and documentation of discarded area are essential for compliance. Quarterly fluctuations in HCPCS pricing further underscore the need for updated reference sheets within practices. Second-intention (SI) as baseline. Even with conservative supply-only costing (favoring the skin-substitute arm), SI remained dramatically less expensive for these moderate-sized defects. This does not negate potential quality-of-life benefits of biologics in selected cases, but it underscores the need for transparent shared decision-making and prior authorization processes where applicable. Limitations. Prices and reimbursements were vendor-reported, may be subject to change, and can vary by contracts, geography, and quarter. We did not validate clinical closure times or head-to-head effectiveness; closure horizons were based on vendor statements and pragmatic assumptions. Results should therefore be interpreted as financial modeling, not clinical efficacy. Conclusions For post-Mohs defects of 14–16 cm², placenta-derived skin substitutes can rapidly accumulate large costs over serial applications. We recommend (1) explicit pre-use cost modeling per patient, (2) rigorous waste minimization and correct coding, (3) clear medical-necessity documentation, and (4) routine consideration of SI or autologous/standard reconstructive options when clinically acceptable. Practical Takeaways for Dermatologic Surgeons Build a product-agnostic cost sheet that maps area in order to minimize-waste size, HCPCS units, acquisition net price, and local MAC rates. Default to SI for moderate, well-vascularized defects unless specific clinical factors justify biologics. When using biologics, limit total applications; reassess after each week. Maintain waste ≤ 10% and document discarded area. Align CPT (15275 vs 15271) with anatomic site; append add-on codes when indicated. Declarations Disclosures Authors report no financial relationships with the manufacturers listed, beyond receiving pricing/coding information for the purposes of this analysis. Funding/support: None. Conflicts of interest / disclosures: The authors report no relevant financial relationships with manufacturers of placenta-derived skin substitutes. Vendors provided pricing/coding information in response to a standardized inquiry for the purposes of this analysis. IRB / ethics statement: This work used vendor pricing/coding information and scenario-based financial modeling and did not involve human participants or identifiable patient data; institutional review board review was not required. Patient consent: Not applicable. Data availability: All pricing/coding inputs used in this manuscript were provided directly by vendors in response to our standardized email inquiry. Acknowledgments: None. Author Contribution A wrote the manuscript text and A and B both contributed to the development and review of the manuscript References Toman J, Adams JR, Choi M, Mason D, Hubbs BS, Forsyth RA, Rogers GS (2025) Placental allograft reconstruction of cutaneous wounds following Mohs surgery: a propensity score–matched comparative cost-effectiveness analysis. J Drugs Dermatol 24(5):450–456. 10.36849/JDD.8436 Ingraldi AL, Tabor AJ, Lee D et al (2023) Post-Mohs surgical defect repair with dehydrated human amnion/chorion membrane graft: a retrospective clinical case study. Acquaint Publ J Med 3(1):1–6 Jafry M, Hanke CW (2025) Escalating Medicare payment for new skin-substitute Q-codes: rapid growth without proven added value, 2022–2025. J Am Acad Dermatol S0190–9622(25):03179–03172. 10.1016/j.jaad.2025.11.013 Kapp D, Pfendler L (2024) Management of post-Mohs surgical wounds with a hypothermically stored amniotic membrane: a case series. J Wound Care 33(Suppl 5):S22–S29. 10.12968/jowc.2024.33.Sup5.S22 Lyons AB, Coleman JE, Razzano P et al (2018) Dehydrated human amnion/chorion membrane allograft as skin substitute for wounds including Mohs micrographic surgery defects. JAAD Case Rep 4(3):222–228. 10.1016/j.jdcr.2017.11.015 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 Feb, 2026 Reviewers agreed at journal 11 Feb, 2026 Reviews received at journal 10 Feb, 2026 Reviewers agreed at journal 10 Feb, 2026 Reviewers invited by journal 10 Feb, 2026 Editor assigned by journal 02 Feb, 2026 Submission checks completed at journal 02 Feb, 2026 First submitted to journal 31 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8752523","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589730296,"identity":"0b8e399f-0f27-4b83-92d8-c96be1c6f0cd","order_by":0,"name":"Mustufa Jafry","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYFCCgw0HPlTYJIDZCQVEaTl88OCMM2kJDGwgLQZEaWFLPszbdhiihYEYLbqNZwwO87Cdz+OX70788MCAQZ5f7AB+LWYHzhgcnMNzu1iyjXezBNBhhjNnJxDWcuCNxO3EDcd4N4C0JBjcJkYLj8E5kJbNP4jUcizhIE/CAZCWbcTacvjAwRkHkhNntuVus0gwkCDCLzcONn/4+M8usZ/57OabPyps5PmlCWhhkDiAyiWgHAT4G4hQNApGwSgYBSMbAACxTVBi0JodewAAAABJRU5ErkJggg==","orcid":"","institution":"Laser and Skin Surgery Center of Indiana","correspondingAuthor":true,"prefix":"","firstName":"Mustufa","middleName":"","lastName":"Jafry","suffix":""},{"id":589730297,"identity":"c7e6bff2-c018-431e-ae57-295f320858b7","order_by":1,"name":"William Hanke","email":"","orcid":"","institution":"Laser and Skin Surgery Center of Indiana","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"","lastName":"Hanke","suffix":""}],"badges":[],"createdAt":"2026-01-31 21:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8752523/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8752523/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102757658,"identity":"81344369-a0d8-41fb-8c4f-117d6a5278a0","added_by":"auto","created_at":"2026-02-16 10:04:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":630471,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative \u0026nbsp;post-Mohs defect scenarios used for cost modeling. (A) Forehead defect \u0026nbsp;measuring 4 × 4 cm (16 cm²) with depth to temporalis fascia; modeled as \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;the face/scalp anatomic class for application coding. (B) Medial foot defect measuring 4 × 3.5 cm (14 cm²) with depth to deep subcutaneous fat; \u0026nbsp;modeled as the feet anatomic class for application coding. These \u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;standardized scenarios served as inputs for weekly placenta-derived skin substitute application modeling and comparison with second-intention (SI) \u0026nbsp;healing.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8752523/v1/b7d546e359c3994d8a210814.png"},{"id":102757657,"identity":"86b8f870-f37e-4d3f-91f7-76c4feae0f26","added_by":"auto","created_at":"2026-02-16 10:04:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":173071,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eModeled cumulative practice acquisition cost by number of placenta-derived skin substitute applications (1–10).\u003c/strong\u003e\u003cbr\u003e\nCumulative acquisition cost is plotted against the number of weekly applications for representative products spanning lower-, mid-, and higher-cost categories: MiMedx EpiFix (4 × 4.5 cm), Organogenesis Cygnus Dual (4 × 4 cm), and ConvaTec InnovaMatrix AC (4 × 4 cm). For each product, the modeled sheet size was the smallest that covered a 14–16 cm² defect while targeting ≤10% waste when feasible. Costs increase linearly with additional applications, illustrating the rapid escalation in total expenditure with serial use in moderate-sized post-Mohs defects\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8752523/v1/23788a7292ea39ad5bb768df.png"},{"id":103056393,"identity":"8a0af122-591b-4eb8-ba95-8af75a885edc","added_by":"auto","created_at":"2026-02-20 09:08:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2517860,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8752523/v1/ed4b48d7-5375-4af9-80bf-6c2062926bc2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cost Modeling of Placenta-Derived Skin Substitutes Versus Second-Intention Healing for Post-Mohs Defects: A Pricing Inquiry and Scenario Analysis","fulltext":[{"header":"Capsule summary ","content":"\u003cp\u003e\u0026bull; \u003cstrong\u003eWhat is known:\u003c/strong\u003e Placenta-derived skin substitutes are increasingly used after Mohs surgery, but costs and reimbursements are highly variable. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026bull; \u003cstrong\u003eWhat this adds:\u003c/strong\u003e In modeled 14\u0026ndash;16 cm\u0026sup2; defects, cumulative product acquisition reached ~$6k\u0026ndash;$210k versus \u0026lt;$500 for SI healing, supporting pre-use cost modeling, waste control, and necessity documentation. \u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003ePlacenta-derived skin substitutes, including dehydrated amnion/chorion membranes, hypothermically stored matrices, and multi-layer constructs, are increasingly incorporated into the management of complex cutaneous wounds and select post-Mohs defects where primary closure, flaps, or full-thickness grafts are suboptimal\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.However, the financial implications for dermatologic practices and Medicare are opaque, with wide variation in acquisition price, billable units, product-specific HCPCS codes, and maximum units of service (MUEs)\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough several cost-effectiveness analyses have examined amniotic products in chronic ulcers, few studies address the real-world costs of placenta-derived grafts specifically in post-Mohs surgery, where the postoperative global period limits billable visits, moderate-sized defects may be amenable to SI, and products are often applied serially. Understanding these costs is essential as new Q-codes and high-priced matrices continue to enter the market.\u003c/p\u003e \u003cp\u003eWe therefore performed a standardized pricing inquiry and scenario-based cost model using two representative post-Mohs defects to quantify practice-side spend and modeled Medicare reimbursements and compare these values to SI healing.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePricing Inquiry\u003c/h2\u003e \u003cp\u003eIn 2025, we sent a structured email requesting (1) practice acquisition costs, (2) recommended graft sizes and application frequency, (3) HCPCS codes and per-unit Medicare amounts (if available), (4) CPT application codes by anatomic class, (5) 1 \u0026times; 1 cm pricing, and (6) operational details (MUEs, consignment, waste rules, POS). Companies providing responses included Samaritan Biologics, MiMedx, Organogenesis, and ConvaTec (InnovaMatrix AC). Responses are quoted numerically in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;3 (verbatim values preserved when provided, including quarterly Medicare amounts and MUEs).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical Scenarios\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eScenario A (Forehead)\u003c/b\u003e: 4 \u0026times; 4 cm post-Mohs defect to temporalis fascia (16 cm\u0026sup2;). Application CPT category: face/scalp class.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eScenario B (Medial Foot)\u003c/b\u003e: 4 \u0026times; 3.5 cm post-Mohs defect to deep subcutaneous fat (14 cm\u0026sup2;). Application CPT category: feet class.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eFigure 1.\u003c/span\u003e Representative post-Mohs defect scenarios used for cost modeling. (A) Forehead defect measuring 4 \u0026times; 4 cm (16 cm\u0026sup2;) with depth to temporalis fascia; modeled as the face/scalp anatomic class for application coding. (B) Medial foot defect measuring 4 \u0026times; 3.5 cm (14 cm\u0026sup2;) with depth to deep subcutaneous fat; modeled as the feet anatomic class for application coding. These standardized scenarios served as inputs for weekly placenta-derived skin substitute application modeling and comparison with second-intention (SI) healing.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBase-case closure horizon\u003c/strong\u003e \u003cp\u003eweekly applications; forehead closes in \u003cb\u003e4 weeks\u003c/b\u003e; foot in \u003cb\u003e6 weeks\u003c/b\u003e. Where vendors supplied medians (multi-center analysis\u0026thinsp;~\u0026thinsp;5 weeks overall), we aligned base-case horizons accordingly and tested \u003cb\u003e1\u0026ndash;10\u003c/b\u003e applications in sensitivity analysis.\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eCoding \u0026 Site of Service\u003c/h3\u003e\n\u003cp\u003eApplication CPT (physician office):\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003e15275\u003c/b\u003e (face, scalp, hands, feet, etc.), first 25 cm\u0026sup2; (or less);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003e15271\u003c/b\u003e (trunk, arms, legs), first 25 cm\u0026sup2; (or less);\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eadd-on codes per 25 cm\u0026sup2;/100 cm\u0026sup2; as applicable.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eCompanies reported HCPCS product codes and per-unit Medicare amounts (varied by quarter and MAC); we used the submitted unit amounts as given. Samaritan Biologics noted Medicare eligibility and POS criteria (POS 11/32) and a 35% Volume Discount (VD) off list with weekly applications allowed up to \u003cb\u003e10\u003c/b\u003e in \u003cb\u003e12\u003c/b\u003e weeks, subject to IVR. We model physician-office setting (POS 11).\u003c/p\u003e\n\u003ch3\u003eSI (Second-Intention) Cost Model\u003c/h3\u003e\n\u003cp\u003eWe assumed SI follow-ups fall under the post-operative global with \u003cb\u003eno separately billable E/M\u003c/b\u003e, using supply-only clinic costs: non-adherent contact layer, secondary dressing, tape, and nurse change time \u003cb\u003e$20\u0026ndash;$40/visit\u003c/b\u003e. Forehead (4 visits): \u003cb\u003e$80\u0026ndash;$160\u003c/b\u003e plus initial bulky dressing (\u003cb\u003e$40\u0026ndash;$160\u003c/b\u003e), total SI \u003cb\u003e$120\u0026ndash;$320\u003c/b\u003e. Foot (6 visits): \u003cb\u003e$120\u0026ndash;$240\u003c/b\u003e plus initial (\u003cb\u003e$60\u0026ndash;$240\u003c/b\u003e), total SI \u003cb\u003e$180\u0026ndash;$480\u003c/b\u003e. These conservative ranges intentionally favor the skin-substitute arm in comparative costing.\u003c/p\u003e\n\u003ch3\u003eCalculations\u003c/h3\u003e\n\u003cp\u003eFor each product, we selected the smallest size covering the wound area while minimizing waste per vendor guidance (\u0026le;\u0026thinsp;10% when possible). We multiplied acquisition cost per application by the number of applications (4 for forehead, 6 for foot). For modeled Medicare product reimbursement, we used vendor-reported HCPCS/unit values and units (or area) per application, adding the appropriate base application CPT amount per application (\u003cb\u003e15275\u003c/b\u003e for both scenarios) from the materials provided. Where a vendor\u0026rsquo;s example CPT conflicted with standard descriptors (e.g., \u003cb\u003e15271\u003c/b\u003e used for a forehead wound), we corrected to \u003cb\u003e15275\u003c/b\u003e for face/scalp/feet per the descriptors supplied in the Organogenesis billing guide.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVendor-Reported Pricing \u0026amp; Coding\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompany\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProduct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSize(s) modeled\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHCPCS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnits/MUE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAcquisition price (per app)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVendor-reported Medicare per-unit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMiMedx\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpiFix (mesh)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026times;4.5\u0026nbsp;cm (18\u0026nbsp;cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(Q-code not provided in email; EpiFix commonly Q41xx)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 BU (per vendor)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$1,495\u003c/b\u003e (or \u003cspan\u003e$\u003c/span\u003e1,405/10-pack)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$1,668.15/app\u003c/b\u003e (vendor total)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24\u0026nbsp;mm disk (5 BU) too small for 14\u0026ndash;16\u0026nbsp;cm\u0026sup2; defects\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMiMedx\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpicord\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026times;5\u0026nbsp;cm (15\u0026nbsp;cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u0026mdash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 BU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$3,535\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$3,679.50/app\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHA-containing option emphasized for cosmesis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMiMedx\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpixpress (3-layer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026times;5\u0026nbsp;cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(\u0026mdash;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 BU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$22,500\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$31,500/app\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh-end, fenestrated; large budget impact\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganogenesis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCygnus\u0026nbsp;Dual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026times;4\u0026nbsp;cm (16\u0026nbsp;cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e04282\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 units/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$5,300\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$487.31/cm\u0026sup2;\u003c/b\u003e (~\u003cspan\u003e$\u003c/span\u003e7,796.96/app)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVendor lists CPT schedules and multiple products\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganogenesis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVia\u0026nbsp;Matrix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026times;4\u0026nbsp;cm (16\u0026nbsp;cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e04309\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 units/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$13,870\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$1,323.96/cm\u0026sup2;\u003c/b\u003e (~\u003cspan\u003e$\u003c/span\u003e21,183.36/app)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganogenesis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAffinity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5\u0026times;2.5\u0026nbsp;cm; need 3 for 16\u0026nbsp;cm\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e04159\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 BU/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$3,825/app\u003c/b\u003e (3\u0026times;\u003cspan\u003e$\u003c/span\u003e1,275)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$262.92/cm\u0026sup2;\u003c/b\u003e (~\u003cspan\u003e$\u003c/span\u003e4,995.48/app via 19 BU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVendor states 3 sheets for 4\u0026times;4\u0026nbsp;cm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConvaTec\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInnovaMatrix\u0026nbsp;AC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026times;4\u0026nbsp;cm (16\u0026nbsp;cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eA2001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16 units/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$10,944\u003c/b\u003e (net @ 40% discount)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e$1,174.20/cm\u0026sup2;\u003c/b\u003e (~\u003cspan\u003e$\u003c/span\u003e18,787.20/app, WPS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eShelf-stable; consignment available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSamaritan Biologics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete\u0026nbsp;AA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSheet sized to area (16\u0026nbsp;cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eQ4303\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMUE\u0026nbsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$35,031/app\u003c/b\u003e (35% VD off \u003cspan\u003e$\u003c/span\u003e3,368.39/cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e80% of list\u003c/b\u003e (~\u003cspan\u003e$\u003c/span\u003e43,115/app)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWeekly apps up to 10 in 12\u0026nbsp;weeks w/ IVR; POS\u0026nbsp;11/32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSamaritan Biologics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMLG\u0026nbsp;Complete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eArea-matched\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eQ4256\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMUE\u0026nbsp;300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$7,644/app\u003c/b\u003e (35% VD off \u003cspan\u003e$\u003c/span\u003e735.04/cm\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e80% of list\u003c/b\u003e (~\u003cspan\u003e$\u003c/span\u003e9,409/app)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCPT application (office)\u003c/strong\u003e \u003cp\u003e \u003cb\u003e15275\u003c/b\u003e \u003cem\u003eface/scalp/feet\u003c/em\u003e, \u003cb\u003e15271\u003c/b\u003e \u003cem\u003etrunk/arms/legs.\u003c/em\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eModeled Cumulative Costs by Scenario (Base-Case Applications) Assumptions\u003c/b\u003e: Forehead 4 apps (weekly \u0026times;4); Foot 6 apps (weekly \u0026times;6); CPT per application \u003cb\u003e15275 = $153.99\u003c/b\u003e (from vendor billing guide). Where vendors supplied an \u0026ldquo;app-total reimbursement,\u0026rdquo; we added CPT only when not already included.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"+\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"+\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProduct (size)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePer-app acquisition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePer-app modeled reimbursement (product only)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eForehead 4 apps: cumulative acquisition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eForehead modeled reimbursement (product only\u0026thinsp;+\u0026thinsp;CPT)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFoot 6 apps: cumulative acquisition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFoot modeled reimbursement (product only\u0026thinsp;+\u0026thinsp;CPT)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiMedx EpiFix 4\u0026times;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e1,668/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$5,980\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e6,672 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$7,287.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$8,970\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e10,008.9 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$10,932.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiMedx Epicord 3\u0026times;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,535\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,679.5/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$14,140\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e14,718 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$15,333.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$21,210\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e22,077 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$23,000.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiMedx Epixpress 3\u0026times;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e22,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e31,500/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$90,000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e126,000 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$126,615.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$135,000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e189,000 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$189,923.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrg. Cygnus\u0026nbsp;Dual 4\u0026times;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e5,300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e7,796.96/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$21,200\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e31,187.84 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$31,803.80\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$31,800\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e46,781.76 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$47,705.70\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrg. Via\u0026nbsp;Matrix 4\u0026times;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e13,870\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e21,183.36/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$55,480\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e84,733.44 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$85,349.40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$83,220\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e127,100.16 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$128,024.10\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrg. Affinity (3\u0026times; 2.5\u0026times;2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e3,825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e4,995.48/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$15,300\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e19,981.92 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$20,597.88\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$22,950\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e29,972.88 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$30,896.82\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvaTec InnovaMatrix\u0026nbsp;AC 4\u0026times;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e10,944\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e18,787.20/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$43,776\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e75,148.80 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$75,764.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$65,664\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e112,723.20 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$113,647.14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSamaritan Complete\u0026nbsp;AA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e35,031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e43,115/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$140,125\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e172,460 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$173,075.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$210,187\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e258,690 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$259,613.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSamaritan MLG\u0026nbsp;Complete\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e7,644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e9,409/app\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e$30,576\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c5\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e37,636 + \u003cspan\u003e$\u003c/span\u003e615.96 = \u003cb\u003e$38,251.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e$45,864\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"+\" colname=\"c7\"\u003e \u003cp\u003e~\u003cspan\u003e$\u003c/span\u003e56,454 + \u003cspan\u003e$\u003c/span\u003e923.94 = \u003cb\u003e$57,377.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSecond-Intention (SI) supply-only clinic costs\u003c/strong\u003e \u003cp\u003eForehead \u003cb\u003e$120\u0026ndash;$320\u003c/b\u003e total; Foot \u003cb\u003e$180\u0026ndash;$480\u003c/b\u003e total (see Methods).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eKey findings:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eLowest-cost option: MiMedx EpiFix 4\u0026times;4.5 cm (\u003cspan\u003e$\u003c/span\u003e1,495/application).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHighest-cost option: Samaritan Biologics Complete AA (\u003cspan\u003e$\u003c/span\u003e35,031/application after discount).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eForehead defect: Cumulative practice spend ranged \u003cspan\u003e$\u003c/span\u003e5,980\u0026ndash;\u003cspan\u003e$\u003c/span\u003e140,125, compared with SI \u003cspan\u003e$\u003c/span\u003e120\u0026ndash;\u003cspan\u003e$\u003c/span\u003e320.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFoot defect: Cumulative spend ranged \u003cspan\u003e$\u003c/span\u003e8,970\u0026ndash;\u003cspan\u003e$\u003c/span\u003e210,187, compared with SI \u003cspan\u003e$\u003c/span\u003e180\u0026ndash;\u003cspan\u003e$\u003c/span\u003e480.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eModeled Medicare reimbursements outpaced acquisition costs in most products but yielded large absolute payer expenditures.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1 Cumulative acquisition cost vs number of applications (1\u0026ndash;10) for representative products (EpiFix 4\u0026times;4.5, Cygnus Dual 4\u0026times;4, InnovaMatrix AC 4\u0026times;4).\u003c/b\u003e \u003c/p\u003e\n\u003ch3\u003eSensitivity Analysis\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eApplications\u003c/b\u003e: Costs scale linearly with number of applications. Even low-cost sheets (e.g., EpiFix 4\u0026times;4.5) exceed SI supply costs by 1\u0026ndash;2 applications.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSheet sizing \u0026amp; waste\u003c/b\u003e: Switching from a 4\u0026times;4 sheet to 3\u0026times; 2.5\u0026times;2.5 (Affinity) reduced per-app acquisition by ~\u003cspan\u003e$\u003c/span\u003e1,475 in the 16 cm\u0026sup2; defect while maintaining reimbursement, highlighting the financial impact of waste minimization.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMAC/quarter variability\u003c/b\u003e: Products with A-/Q-codes priced \u0026ldquo;per cm\u0026sup2;\u0026rdquo; (e.g., InnovaMatrix AC, Cygnus Dual, Via Matrix) produced large swings in modeled reimbursement; quarterly updates can materially alter margins.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDiscounting/consignment\u003c/b\u003e: ConvaTec\u0026rsquo;s net pricing (40% off list in the materials provided) and Samaritan\u0026rsquo;s 35% Volume Discount substantially lowered practice acquisition but did not eliminate large cumulative spend.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCumulative acquisition cost is plotted against the number of weekly applications for representative products spanning lower-, mid-, and higher-cost categories: MiMedx EpiFix (4 \u0026times; 4.5 cm), Organogenesis Cygnus Dual (4 \u0026times; 4 cm), and ConvaTec InnovaMatrix AC (4 \u0026times; 4 cm). For each product, the modeled sheet size was the smallest that covered a 14\u0026ndash;16 cm\u0026sup2; defect while targeting\u0026thinsp;\u0026le;\u0026thinsp;10% waste when feasible. Costs increase linearly with additional applications, illustrating the rapid escalation in total expenditure with serial use in moderate-sized post-Mohs defects\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis pricing inquiry demonstrates that placenta-derived skin substitutes can generate substantial cumulative costs in common post-Mohs scenarios, with orders-of-magnitude variation across brands. For moderate defects (14\u0026ndash;16 cm\u0026sup2;), per-application acquisition ranged from ~\u003cspan\u003e$\u003c/span\u003e1.5k to \u0026gt;\u003cspan\u003e$\u003c/span\u003e35k, and a typical 4\u0026ndash;6-application course produced total practice spend from \u003cspan\u003e$\u003c/span\u003e6k to over \u003cspan\u003e$\u003c/span\u003e200k. While modeled Medicare product reimbursements often outstrip acquisition (creating a positive spread), the absolute payer outlay is high. These findings align with clinicians\u0026rsquo; anecdotal observations that biologic dressings can become expensive quickly when used serially.\u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical considerations.\u003c/b\u003e Our analysis does not argue for or against clinical efficacy in specific Mohs scenarios; rather, it highlights the need to reserve placenta-derived products for carefully selected defects with clear medical necessity (e.g., exposed critical structures, compromised vascularity, or patients unable to tolerate secondary procedures)\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Incorporating cost modeling into shared decision-making may help identify patients who derive disproportionate benefit relative to expense.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDocumentation \u0026amp; compliance.\u003c/b\u003e Several respondents stressed POS eligibility, IVR, and MUE rules. We observed a coding inconsistency in one response (forehead coded as 15271); per descriptors supplied in another vendor\u0026rsquo;s billing guide, 15275 applies to face/scalp/feet and 15271 to trunk/arms/legs. Accurate coding, maintenance of waste\u0026thinsp;\u0026le;\u0026thinsp;10%, and documentation of discarded area are essential for compliance. Quarterly fluctuations in HCPCS pricing further underscore the need for updated reference sheets within practices.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSecond-intention (SI) as baseline.\u003c/b\u003e Even with conservative supply-only costing (favoring the skin-substitute arm), SI remained dramatically less expensive for these moderate-sized defects. This does not negate potential quality-of-life benefits of biologics in selected cases, but it underscores the need for transparent shared decision-making and prior authorization processes where applicable.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations.\u003c/b\u003e Prices and reimbursements were vendor-reported, may be subject to change, and can vary by contracts, geography, and quarter. We did not validate clinical closure times or head-to-head effectiveness; closure horizons were based on vendor statements and pragmatic assumptions. Results should therefore be interpreted as financial modeling, not clinical efficacy.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFor post-Mohs defects of 14\u0026ndash;16 cm\u0026sup2;, placenta-derived skin substitutes can rapidly accumulate large costs over serial applications. We recommend (1) explicit pre-use cost modeling per patient, (2) rigorous waste minimization and correct coding, (3) clear medical-necessity documentation, and (4) routine consideration of SI or autologous/standard reconstructive options when clinically acceptable.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePractical Takeaways for Dermatologic Surgeons\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBuild a product-agnostic cost sheet that maps area in order to minimize-waste size, HCPCS units, acquisition net price, and local MAC rates.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDefault to SI for moderate, well-vascularized defects unless specific clinical factors justify biologics.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eWhen using biologics, limit total applications; reassess after each week.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMaintain waste\u0026thinsp;\u0026le;\u0026thinsp;10% and document discarded area.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAlign CPT (15275 vs 15271) with anatomic site; append add-on codes when indicated.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors report no financial relationships with the manufacturers listed, beyond receiving pricing/coding information for the purposes of this analysis.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding/support:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest / disclosures:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no relevant financial relationships with manufacturers of placenta-derived skin substitutes. Vendors provided pricing/coding information in response to a standardized inquiry for the purposes of this analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB / ethics statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work used vendor pricing/coding information and scenario-based financial modeling and did not involve human participants or identifiable patient data; institutional review board review was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll pricing/coding inputs used in this manuscript were provided directly by vendors in response to our standardized email inquiry.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA wrote the manuscript text and A and B both contributed to the development and review of the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eToman J, Adams JR, Choi M, Mason D, Hubbs BS, Forsyth RA, Rogers GS (2025) Placental allograft reconstruction of cutaneous wounds following Mohs surgery: a propensity score\u0026ndash;matched comparative cost-effectiveness analysis. J Drugs Dermatol 24(5):450\u0026ndash;456. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.36849/JDD.8436\u003c/span\u003e\u003cspan address=\"10.36849/JDD.8436\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIngraldi AL, Tabor AJ, Lee D et al (2023) Post-Mohs surgical defect repair with dehydrated human amnion/chorion membrane graft: a retrospective clinical case study. Acquaint Publ J Med 3(1):1\u0026ndash;6\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJafry M, Hanke CW (2025) Escalating Medicare payment for new skin-substitute Q-codes: rapid growth without proven added value, 2022\u0026ndash;2025. J Am Acad Dermatol S0190\u0026ndash;9622(25):03179\u0026ndash;03172. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaad.2025.11.013\u003c/span\u003e\u003cspan address=\"10.1016/j.jaad.2025.11.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapp D, Pfendler L (2024) Management of post-Mohs surgical wounds with a hypothermically stored amniotic membrane: a case series. J Wound Care 33(Suppl 5):S22\u0026ndash;S29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12968/jowc.2024.33.Sup5.S22\u003c/span\u003e\u003cspan address=\"10.12968/jowc.2024.33.Sup5.S22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyons AB, Coleman JE, Razzano P et al (2018) Dehydrated human amnion/chorion membrane allograft as skin substitute for wounds including Mohs micrographic surgery defects. JAAD Case Rep 4(3):222\u0026ndash;228. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jdcr.2017.11.015\u003c/span\u003e\u003cspan address=\"10.1016/j.jdcr.2017.11.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8752523/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8752523/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePlacenta-derived skin substitutes are marketed for post-Mohs wounds, but financial impact is uncertain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo estimate practice acquisition costs and modeled Medicare product reimbursement for placenta-derived products versus second-intention (SI) healing in two post-Mohs defects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn 2025, vendors provided pricing and coding inputs. We modeled (A) a 4×4 cm forehead defect to temporalis fascia (16 cm²) treated weekly for 4 applications and (B) a 4×3.5 cm medial foot defect to deep subcutaneous fat (14 cm²) treated weekly for 6 applications, using the smallest sheet with ≤10% waste. SI was modeled as supply-only clinic costs during the postoperative global period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFor a 16 cm² defect, per-application acquisition ranged from $1,495 (MiMedx EpiFix 4×4.5 cm) to $35,031 (Samaritan Biologics Complete AA); modeled Medicare product reimbursement ranged from $1,668 to $43,115 per application. Cumulative acquisition was $5,980–$140,125 (forehead) and $8,970–$210,187 (foot) versus SI $120–$320 and $180–$480.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations: \u003c/strong\u003eInputs were company-reported; regional/contract variability was not assessed; closure times were modeled; SI excluded patient-reported outcomes and opportunity costs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Even moderate post-Mohs defects can generate large cumulative expenditures with placental substitutes. Pre-use cost modeling, accurate coding, waste minimization, and documentation of medical necessity should precede routine use.\u003c/p\u003e","manuscriptTitle":"Cost Modeling of Placenta-Derived Skin Substitutes Versus Second-Intention Healing for Post-Mohs Defects: A Pricing Inquiry and Scenario Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 10:04:01","doi":"10.21203/rs.3.rs-8752523/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-11T15:36:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256890830735013218185257519770956751050","date":"2026-02-11T15:35:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T17:31:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259715096437782651260551293771901633506","date":"2026-02-10T17:30:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-10T17:01:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-02T13:53:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-02T13:46:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2026-01-31T20:58:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"c542554a-c1f8-4dac-9a9f-328a0b3cccfb","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-18T17:39:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 10:04:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8752523","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8752523","identity":"rs-8752523","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}