Help Ensure All Women Have Access To Advanced Breast Reconstruction

Help Ensure All Women Have Access To Advanced Breast Reconstruction

Center for Restorative Breast Surgery

Urge the Senate to protect patients’ access to autologous breast reconstruction!


Breast reconstruction can be an essential part of the overall care plan and healing for women facing mastectomy or the after-effects of a failed breast reconstruction. The good news is that advances in microsurgery, many pioneered at the Center for Restorative Breast Surgery, in combination with the latest in breast cancer care, can preserve and restore shape, form, beauty, and function.

However, last year, the Centers for Medicare and Medicaid Services (CMS) put that recovery plan at risk when they announced that the insurance code used for advanced reconstruction procedures would automatically expire on December 31, 2024, as all techniques used are now captured using one CPT code. This code elimination forces microsurgeons to perform less advanced surgical techniques and limits patient treatment options to procedures that may not be muscle-sparing.

Shortly after this change was made, health insurance companies, including UnitedHealthcare and Blue Cross Blue Shield of New Jersey, announced plans to deny coverage starting July 1, 2022. In response, the American Society of Plastic Surgeons petitioned UnitedHealthcare to get the coverage denial temporarily reversed.

Senators Marsha Blackburn (R-TN) and Amy Klobuchar (D-MN) are at the forefront of legislation to ensure that breast cancer survivors who choose reconstructive surgery after a mastectomy have proper insurance coverage. They have co-authored a letter to CMS encouraging them to reinstate coverage for breast reconstruction code S2068 for DIEP procedures.

Now is the time to ask your member of Congress to sign on to a bipartisan letter to CMS urging the agency to protect patients’ access to the best breast cancer treatment options available.

We encourage you to send a letter to your U.S. Senators today, urging them to protect patient access to breast reconstruction!

It will only take a minute of your time, as we have already written a template letter for you.

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Senators

  • Ron Wyden OR
  • Debbie Stabenow MI
  • Maria Cantwell WA
  • Robert Menendez NJ
  • Thomas R. Carper DE
  • Benjamin L. Cardin MD
  • Sherrod Brown OH
  • Michael F. Bennet CO
  • Robert P. Casey, Jr. PA
  • Mark R. Warner VA
  • Sheldon Whitehouse RI
  • Maggie Hassan NH
  • Catherine Cortez Masto NV
  • Elizabeth Warren MA
  • Chuck Grassley IA
  • Mike Crapo ID
  • John Cornyn TX
  • John Thune SD
  • Richard Burr NC
  • Rob Portman OH
  • Patrick Toomey PA
  • Tim Scott SC
  • Bill Cassidy LA
  • James Lankford OK
  • Steve Daines MT
  • Todd Young IN
  • Ben Sasse NE
  • John Barrasso WY
  • John Kennedy LA

Letter To Senators

Subject: Protect Patients’ Access to Autologous Breast Reconstruction

Dear Sir/Madam,

As a woman and a constituent, I request that you sign on to the letter from Senators Marsha Blackburn (R-TN) and Amy Klobuchar (D-MN) 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 woman the option to transfer their own abdominal tissue to be used for the reconstruction of the breasts instead of using a medical implant device. A woman’s decision to undergo breast reconstruction post-mastectomy is highly 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. This procedure leads to undesirable health outcomes such as extended 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 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 we deserve access to the highest-quality breast reconstruction treatments available.
 
Thank you for your attention to this very important issue.