Potential Change to Medical Billing Codes Affecting DIEP Flap Surgeries

Medical procedures are billed to insurance using codes determined by the CMS (Centers for Medicare & Medicaid Service). Until recently, DIEP flap breast reconstruction surgery had a unique code that allowed it to be covered by health insurance.

Due to a restructuring by CMS, the unique code assigned to DIEP flap will be phased out by December 31st, 2024. Essentially, it will be impossible for surgeons to bill insurance companies for the surgery.

What is DIEP Flap Surgery?

DIEP flap surgery is a reconstructive procedure that uses a patient's own tissue to recreate the breast after mastectomy. More than 137,000 women who have been diagnosed with breast cancer elect to undergo some form of breast recontruction surgery every year. DIEP flap has been a preferred procedure by many patients.

What will happen to those who want DIEP flap surgery?

If the change takes effect, people will either have to pay out of pocket for the surgery (which can run upwards of $50,000) or choose an alternative treatment option. TRAM Flap surgery is one of the alternatives on the list because it will be the surgery for which surgeons can most easily bill. However, TRAM flap surgery is a much older, less common procedure that has a longer recovery time and higher risk of long-term complications.

Decisions about treatment after a breast cancer diagnosis are deeply personal and require a lot of thought. Therefore, this change will have rippling effects among survivors.

What can we do to help?

Members of our Congress are calling for CMS to reverse it's decision. Senator Amy Klobuchar and Congresswoman Debbie Wasserman Schultz (both breast cancer survivors) are leading the charge - but there are many things you can do to help!

Advocacy Matters

1. Advocate for yourself and others by contacting your local representatives and senators.
2. Dr. Potter has generated letters you can use to help in your efforts. Check out her resources here.
3. Contact your insurance provider and express your concerns.
4. Sign the Triage Cancer Petition to CMS to Reinstate Breast Reconstruction Surgery Code S2068

Share Your Story

1. Share your story on social media and beyond to help others understand why access to these reconstruction options matter.

See BRA Volunteer, Board Member, and Friend share her story on FOX 17 here: