Patient and Professional Advocates Petition CMS to Ensure Access to DIEP Flap Breast Reconstruction

By: Lauren Velentzas
Posted: Tuesday, April 11, 2023

In January 2021, the Centers for Medicare and Medicaid Services (CMS) announced the sunsetting of code S2068 of the Women’s Health and Cancer Rights Act of 1998, which provides protections to individuals who want breast reconstruction after a mastectomy. Code S2068 protected access to deep inferior epigastric perforator (DIEP) flap breast reconstruction surgery; without it, many private payers are no longer differentiating between the DIEP flap and transverse rectus abdominis (TRAM) flap surgery. Thus, reimbursement for the surgery is much lower, making the search for experienced surgeons a struggle for many patients. On April 3, advocates delivered a letter and petition to CMS, urging the reinstatement of code S2068.

The petition was signed by more than 4,600 individuals across the country, along with 34 patient advocacy organizations; 12 medical professional societies; and 231 health-care professionals from hospitals, practices, and individual health-care providers. In 2020 alone, 25,000 of the 137,000 individuals who underwent breast reconstruction surgery received DIEP flap breast reconstruction. The surgery is preferred by many patients because of its reduced hospitalization and quicker recovery times. It is also a critically important option for patients who have received or will need radiation treatment.

“These code changes run contrary to the intent behind the Women’s Health and Cancer Rights Act and are causing real barriers to care for individuals seeking access to medically appropriate breast reconstruction after a cancer diagnosis,” said Shelley Fuld Nasso, MPP, Chief Executive Officer of the National Coalition for Cancer Survivorship.

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