Measurement Accuracy and CTPs: Viewpoints on Driving Outcomes

• CTPs (cellular- and tissue-based products), US wound care setting: MAC coverage decisions hinge on documented wound size, baseline measurement, failure of standard care, and progression. Inaccurate baseline measurements can affect product choice, number of applications, and reimbursement.
• Medicare OPPS/PFS changes (effective Jan 1; discussion as of Mar 2): Wound size thresholds (e.g., >100 cm², additional 25 cm²) determine payment categories, increasing scrutiny of measurement accuracy and documentation.
• Clinical documentation: Narrative descriptions alone (e.g., “granulating well”) are insufficient; clinicians must document square centimeters, surface area, volume, and reduction over time to support medical necessity and reduce audit risk.

Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text. 

Mr. Nelson is the VP Sales & Marketing for Swift Medical and Founder of the WoundCareFund & Below the Knee.

Hello. Appreciate the opportunity to speak with everybody today and wanted to take advantage of some topical information that I think we're all hearing about, talking about. I know I'm having a lot of conversations and today really want to talk about measurement accuracy and how that can drive outcomes and a lot of information around that. 
 
So in today's wound care environment, measurement isn't just about tracking progress. It's really about kind of protecting the practice from a documentation, from a storytelling, from the medical necessity, and really connecting all those dots. So as we settle into some of the new PFS and OPPS structures, it's now March 2nd, these started January 1st. It's not been a long time. So as we really settle into some of these new structures, we're definitely continuing to see some increased scrutiny and questions around CTP utilization, wound size. We're hearing a lot of conversations around wastage versus the size of the CTP versus the size of the wound. How do we really absolve ourselves and kind of move toward a defined direction around here? 
 
So one thing is if your measurement is not accurate, consistent and defensible, that's a risk base. So you're risking revenue, you're risking audit exposure. So really over the next couple of minutes, let's kind of talk about why precision and consistency now matter more than ever. 
 
So measurement as medical necessity. What does that mean? So let's start at the beginning, the baseline. So MACs, we all have a MAC no matter where we live. Novitas, First Coast, Palmetto, you should know what MAC you're in. And if not, find out. And you may be spanning a couple if you're in a larger practice. But the MACs are clear. Medical necessity for CTPs, it really hinges on documented wound size. So documented failure of standard care, documented progression. So if you're not reducing the wound size.
 
So your baseline really sets that entire episode. If your initial measurement isn't accurate, everything that follows is also not accurate. Product choice, number of applications, reimbursement, all rest on kind of that shaky ground of what was that initial accuracy of the measurement. 
 
Your size drives payment category. So under OPPS, you can cross size thresholds, meaning am I greater than 100, a second 25 square centimeters. So what are those size thresholds that is based off that initial baseline that we took? And are we seeing that wound area reduce? You may not because you're seeing granulation buildup. Again, that's a measurement. So are we seeing these size thresholds change based and these are going to drive the reimbursement? So again, that precision, it's not optional. Accuracy is optimal and consistency is really going to be more important. 
 
And the narrative alone won't carry you anymore. It used to be, "Hey, granulating well,” that was okay. And it's not okay anymore. So now that's not going to justify a high-cost product application, high cost. I know there's some eye rolls going on right now with the prices that are changed, but it's still considered a high-cost application. And you need more than just a high-level descriptor. So really, what are the square centimeters? What is the surface area? What is the volume? What is the reduction? What's the consistency that I'm getting in the accuracy that's going to really tell the story? So measurement is the foundation of the necessity in this particular area. And if that foundation cracks, the entire claim can kind of collapse below that.