Protect access to
Modern Breast
Reconstruction
What can you do today to protect a woman’s access to Modern Breast Reconstruction?
The American Medical Association (AMA) chose to make an editorial change to a code in the Current Procedural Technology (CPT) book that has the potential to restrict access to the most modern breast reconstruction techniques for women. Specifically, these procedures are the DIEP, GAP, SIEA, and other hybrid procedures that do not sacrifice much-needed muscles of a woman’s body.
While this may seem like a simple change to the AMA, it created an avenue for BIG INSURANCE to request to delete the codes that providers have historically used within an alternate coding system (HCPCS) that appropriately describe these modern procedures.
We cannot find within the Executive or CPT Editorial Panel Summary of Actions where this revision went through the process for approval as outlined on the AMA website. Had that happened, we are confident that the public and surgeons who frequently perform these procedures would have spoken out against it before now.
We are gathering support to send a request to the American Medical Association Board of Trustees asking that they investigate how this revision, which negatively impacts the access for all women, was allowed to be added to the CPT without comment or survey.
We need to act quickly to protect our access.
Let’s let BIG INSURANCE know they cannot take away our breast reconstruction options without our consent.
Subject: Protect Patients’ Access to Modern Breast Reconstruction Techniques
Dear Senator___________________,
As a woman and a constituent, I request that you please sign on to the letter from Senators Marsha Blackburn (R-TN), Amy Klobuchar (D-MN), Tina Smith (D-MN), Ben Luján (D-NM), Cory Booker (D-NJ), Roger Marshall, MD (R-KS), and Gary Peters (D-MI) 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 continue coverage for codes S2066, S2067, and S2068 for SGAP, Stacked, and Deep Inferior Epigastric Perforator flap (DIEP flap) procedures, which offer life-changing breast reconstruction for women with breast cancer. These medically advanced breast reconstruction techniques give a woman the option to use her own tissue without sacrificing muscle structure/function to reconstruct 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 and most advanced treatment options without restriction.
Last year, CMS announced they would be sunsetting these codes, effective December 31, 2024, as all these “perforator flap” reconstructive techniques would be lumped into one old CPT code, despite critical differences from the primitive procedures with which CMS will group them. These older, less advanced procedures can lead to undesirable health outcomes such as extended hospitalizations, recoveries, and health complications such as hernia and permanent muscle weakness. The unintended consequence will leave women forced to choose inferior reconstructive options that insurance would cover as access to advanced procedures dwindles. This move by CMS has also spurred insurance carriers such as Blue Cross Blue Shield of New Jersey to follow suit with early announcements of their intention to stop coverage for the DIEP flap procedure—leaving breast cancer patients vulnerable.
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 there are 3.8 million women survivors in the U.S. today. We deserve access to the highest-quality breast reconstruction treatments available.
Thank you for your attention to this very important issue.
Reach Us
Address
1300 Hospital Drive, Suite 120
Mt. Pleasant SC, 29464