Help Ensure All Women Have Access To Advanced Breast Reconstruction

Petition to CMS to Reinstate
Breast Reconstruction Surgery Code S2068

We, as patients, caregivers, and advocates working on behalf of individuals facing breast cancer, are asking you to ensure that patients continue to have access to all medically appropriate breast reconstructive surgeries, by reversing the decision to eliminate code S2068, which provides coding for DIEP Flap, GAP Flap and modern natural tissue breast reconstructive options.

Breast cancer is the most common type of cancer diagnosed in the United States. After a diagnosis, a patient has to make many difficult decisions, including about whether they should have a mastectomy and whether or not to have reconstruction and what type.

With medical advancements, more reconstructive procedures have become available, including DIEP Flap, GAP Flap and modern natural tissue breast reconstructive options. These procedures allow the use of the patient’s own tissue to reconstruct the breast and are reported to have better outcomes, reduced pain, less complications, and quicker recovery periods than other reconstructive surgeries.

The decision to group all breast reconstruction surgeries under the same CPT code has raised concerns about whether patients will be able to access DIEP Flap, GAP Flap and modern natural tissue breast reconstructive options, as insurance companies will only reimburse for the less advanced surgery.

The lack of adequate reimbursement may lead doctors to choose not to perform the surgery, given the costs to provide it. Alternatively, surgeons may only offer the surgery if patients can pay out of pocket.

We are especially concerned about the impact this will have on patients who are already disproportionately burdened by this diagnosis, as it will increase already existing health outcomes and disparities.

We urge CMS to reinstate code S2068, to guarantee patient access to DIEP Flap, GAP Flap and modern natural tissue breast reconstructive options.