Embracing Progress: CMS Upholds Vital S-Codes for Autologous Breast Reconstruction

Thanks to the hearts of an extraordinary community – comprised of breast cancer survivors, patients, healthcare professionals, advocates and concerned citizens – August 21, 2023 now represents a pivotal juncture in which the Centers for Medicare & Medicaid Services (CMS) unveiled a decision with far-reaching implications.

The Healthcare Common Procedure Coding System (HCPCS) is a collection of standardized codes that represent common procedures, supplies, products and services used universally. Codes S2068, S2067, and S2068 – symbols of access, empowerment and choice – will continue to grace the landscape of medical care (woohoo!). A noteworthy victory unfurls as these codes, once at risk of being sunsetted on December 31, 2024, have been preserved, fortified by the collective spirit of advocacy.

To learn more detail about what's been going on, here's a little back information:

An alteration in medical billing procedures had the potential to introduce challenges in accessing DIEP flap breast reconstruction surgery. This intricate procedure, historically covered by the majority of commercial health insurance companies since 2007, was faced with the prospect of losing its coding. As a consequence, many plastic surgeons would have soon found themselves in a predicament, unable to bill insurance providers at a rate that accounts for the costs associated with this technique and most likely, forced to withdraw this advanced surgical option with their patients.

According to the American Society of Plastic Surgeons (ASPS), over 137,000 individuals who receive a breast cancer diagnosis opt for breast reconstruction surgery annually. Among the array of procedures, DIEP flap reconstruction is an innovative and sought-after method. It holds a special appeal for many women due to its utilization of the individual's own transplanted tissue in lieu of implants, yielding a more natural cosmetic result and avoiding the need to relocate or incise muscle. This precision results in a swifter recovery period and mitigates the likelihood of long-term complications, differentiating it favorably from the TRAM flap surgery alternative.

This momentous achievement is not only a triumph for the present but a testament to the relentless dedication of an entire community over the past few months. The advocacy, commitment and voices have ensured that coverage remains safeguarded, that access remains unhindered and that choices remain unburdened for those confronting breast cancer and navigating the path of reconstruction.

With profound gratitude, we extend a heartfelt THANK YOU to each and every person who joined hands in making this decision a reality. The victory is a reminder that advocacy is not merely an action – it can be a movement that uplifts, empowers and shapes the course of healthcare.

As we celebrate this milestone, let's also acknowledge the potential that lies ahead - a potential to forge change, protect rights and champion the autonomy of everyone on a breast cancer journey.

“This reversal means women emerging from a life-threatening breast cancer fight can now breathe a small sigh of relief. To survive a deadly battle with breast cancer, women need to reclaim their life – not face fewer reconstruction options, financial anxiety, and medical uncertainty. Saving access to DIEP flap breast reconstruction option required CMS to reverse course, and that would not have happened if not for my diligent Congressional colleagues, cancer advocacy groups, watch-dog journalists and dedicated medical professionals, especially Dr. Elisabeth Potter. This fight is not over, of course, as we’ll need to work closely with private payers to ensure adequate reimbursement for microsurgeons. But this latest CMS decision will provide women with more certainty, and help ensure fair and equitable access to their choice of breast reconstruction techniques.” – Congresswoman Wasserman Schultz