CMS Signals Support for Reinstating Breast Reconstruction Codes

VBCF reported in late spring that the federal Centers for Medicare and Medicaid Services (CMS) would hold a June 1st public meeting to reconsider its decision to sunset the medical codes that cover deep inferior epigastric perforator (DIEP) flap reconstruction. VBCF submitted public comments to CMS asking them to reinstate the codes - and we were not alone! CMS received an "overhelming response from physicians, patients, and advocate groups" about retaining the codes and is now reviewing those comments. They will issue a final decision on the matter “in the near future.” We are cautiously optimistic about a favorable outcome and will keep you posted!

Background:

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. VBCF was among the over 30 patient advocacy organizations that signed a letter to CMS in early April 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 signed a petition that was included in the letter.

For additional background see: The Future of DIEP Flap or Go to the Community Breast Reconstruction Alliance webpage to learn more and find other ways you can take action.