CMS to Reconsider Breast Reconstruction Code

We have a great update to share regarding VBCF's efforts to preserve access to deep inferior epigastric perforator (DIEP) flap breast reconstruction. Last Monday, 5/1/23, the federal Centers for Medicare and Medicaid Services (CMS) announced that it is reexamining its decision to sunset the S code for DIEP flap reconstruction and is seeking public input at a June 1 public meeting. This is wonderful news and is a direct result of the advocacy by patients, patient advocacy organizations, professional societies, and healthcare professionals!

In early April, VBCF was among the over 30 patient advocacy organizations that signed a letter to CMS asking them to reinstate the procedure code essential for access to DIEP flap breast reconstruction. The letter was also signed by 12 medical professional societies and 231 healthcare professionals, including hospitals, practices, and individual healthcare providers. Additionally, over 4,600 individuals (maybe even a few of you!) signed a petition that was included in the letter.

Catch up Quickly:

VBCF is part of the Community Breast Reconstruction Alliance (CBRA), a group of patient advocacy organizations and healthcare providers who are advocating for access to deep inferior epigastric perforator (DIEP) flap breast reconstruction procedures. DIEP flap breast reconstruction is a specialized surgery that allows individuals to use their natural tissue to rebuild their breast(s) rather than using implants.

Access to DIEP flap reconstruction is at risk because CMS planned to eliminate three procedure insurance codes and instead group all autologous (or "flap") breast reconstruction surgeries under the same insurance code. Some health plans are moving quickly to use the new code and only reimburse for less advanced surgery and/or reduce payment for DIEP flap procedures. If action is not taken, DIEP flap surgery may only be an option for those who can pay out of pocket for the surgery - at a cost of up to $50,000 or more.

VBCF believes breast cancer patients should have affordable access to all reconstruction options and choose which one is best for them in consultation with their doctor. For additional background see: The Future of DIEP Flap

Take Action:

1) Send comments to CMS by June 1st: If you have personal experience and perspective about DIEP flap surgery, please share your comments to HCPCS@cms.hhs.gov by 5pm on June 1, 2023. In particular, please share any obstacles that you have faced accessing this surgery.

2) Are you considering or have you had DIEP flap surgery? We want to hear from you. Please get in touch with VBCF's Policy Manager, Kirsta Millar (kirsta@vbcf.org) if you are willing to share your experience. Your story will help us as we advocate on this issue.

3) Go to the Community Breast Reconstruction Alliance webpage to learn more and find other ways you can take action.