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Preserving Your Breast Reconstruction Options


The American Society of Plastic Surgery has a long history of fighting for women rights when it comes to breast reconstruction after surgery. Unfortunately, no matter how logical coverage for this right seems, the battle will never end.

Last year, CMS announced that coverage for breast reconstruction code S2068, for deep inferior epigastric perforator flap (DIEP flap) procedures would sunset as of Dec. 31, 2024. This means Medicare will no longer pay for this common method of breast reconstruction, one of a few that do not use breast implants. History shows that when Medicare stops paying for a procedure, every other insurance follows suit. In fact, shortly after CMS made the announcement, commercial payors, including UnitedHealthcare and Horizon Blue Cross Blue Shield of New Jersey, announced their plans to deny coverage for this procedure starting July 1, 2022, giving providers, and breast cancer patients, less than three months notice of the change.

Pink Ribbon Breast Cancer Awareness

Breast Cancer Reconstruction Awareness is also important with 1 in 8 women having the diagnosis of Breast Cancer during their lifetime.

I am posting early this week to ask you to write to your representatives in support of Reps. Debbie Wasserman Schultz and Fred Upton’s letter to the Centers for Medicare and Medicaid Services (CMS) to protect breast cancer patients’ rights and access to quality breast cancer treatment under the Women’s Health and Cancer Rights Act.

Here is a copy of my letter to my Representative. Feel free to copy it to your representative. The deadline is this Friday, July 29, 2020.

    Dear Honorable Representative Mark DeSaulnier:

    As a physician and your constituent, I request that you sign on to Reps. Debbie Wasserman Schultz and Fred Upton’s letter to the Centers for Medicare and Medicaid Services (CMS) to protect breast cancer patients’ rights and access to quality breast cancer treatment under the Women’s Health and Cancer Rights Act.
    The congressional sign-on letter would urge CMS to reinstate coverage for code S2068 for deep inferior epigastric perforator flap (DIEP flap) procedure, which is a life-changing breast reconstruction procedure. This medically advanced breast reconstruction technique gives patients the option to transfer their own abdominal tissue to be used for the reconstruction of the breasts instead of the use of a medical implant device. A patient’s decision to undergo breast reconstruction post-mastectomy is extremely personal and they should have access to the safest treatment options without restriction.

    Last year, CMS announced they would be sunsetting this code, effective December 31, 2024, as all perforator flap reconstructive techniques are described using one CPT code which will ultimately force surgeons to perform older surgical techniques that carry more severe morbidity, such as the TRAM flap. This procedure in particular leads to undesirable health outcomes such as longer hospitalizations and recoveries, and health complications such as hernia and permanent muscle weakness. This move by CMS has also spurred insurance carriers such as UnitedHealthcare and Horizon Blue Cross Blue Shield of New Jersey to follow suit by also stopping coverage for the DIEP flap procedure – leaving breast cancer patients vulnerable.

    UnitedHealthcare Original Coverage Denial: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/rpub/UHC-COMM-RPUB-April-2022.pdf

    Horizon Blue Cross Blue Shield of New Jersey Coverage Denial: https://www.horizonblue.com/providers/policies-procedures/policies/reimbursement-policies-guidelines/free-flap-breast-reconstruction

    One in eight women will be diagnosed with breast cancer in their lifetimes and they deserve access to the highest-quality breast reconstruction treatments available.
    Please join Reps. Wasserman Schultz and Upton in calling on CMS to protect breast cancer patients’ right to quality reconstructive care by reinstating coverage for S2068. To sign on to the letter or for more information, please contact Patrick Koetzle with Rep. Wasserman Schultz at [email protected] The deadline to sign on to the letter is Friday, July 29 at COB.

    Dr. Joseph Mele

Thank you for your support with this important legislation. More information about this and other insures related to plastic surgery can be found at: ASPS Advocacy.



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