Recently, VBCF joined the Community Breast Reconstruction Alliance (CBRA), a group of patient advocacy organizations and healthcare providers working together to advocate for access to deep inferior epigastric perforator (DIEP) flap breast reconstruction surgery. Access to DIEP flap reconstruction is at risk because the federal Centers for Medicare and Medicaid Services (CMS) announced plans 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.
What is DIEP flap reconstruction surgery?
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. The use of natural tissue results in lifelong breast reconstruction, as opposed to implant-based reconstruction because implants must be replaced after 10 or 15 years. DIEP flap surgery also differs from other flap reconstruction procedures, such as TRAM flap, because it uses advanced microsurgery to preserve a person’s abdominal muscles. This procedure creates better long-term health outcomes than older surgeries that removed a patient’s muscle.
Why is DIEP flap at risk?
Access to DIEP flap reconstruction is at risk because the Centers for Medicare and Medicaid Services (CMS) announced plans to eliminate three procedure codes, and some health plans are moving quickly to use the new code and reduce payment for DIEP flap. If medical providers can only bill insurance for a less expensive surgery option, it will be left to patients to make up the difference in cost and, therefore, finanically out of reach for many. 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 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 with the letter. VBCF will continue to track this issue and advocate for access.
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 VBCF advocates on this issue.
To Learn More:
Community Breast Reconstruction Alliance webpage
CBS News recently featured Dr. Elizabeth Potter, a surgeon who has been raising concerns about the impact of medical coding changes on access to DIEP flap.
Article: New Medical Coding Changes Put DIEP Reconstructions at Risk
