BISA joins CBRA to protect access to DIEP Flap Reconstruction

Mar 16

Written By Breast Implant Safety Alliance

BISA wants to protect the right to access to all reconstruction options. We are pleased to announce that BISA has partnered with Community Breast Reconstruction Alliance (CBRA)

The Women's Health and Cancer Rights Act (WHCRA) of 1998 was put into place as a federal law to protect a patient's right to choose breast reconstruction and have it covered by insurance; however not all types of reconstruction are protected.

An upcoming change in medical billing code could eliminate health insurance coverage for a surgery called deep inferior epigastric perforator (DIEP) flap breast reconstruction, a surgery that uses tissue from the lower abdomen to create a new breast.

On March 14, 2023, the Susan G. Komen Foundation, published this blog article on their website:

Until recently, DIEP flap breast reconstruction and other perforator flap breast reconstruction surgeries had unique billing codes administered by the Centers for Medicare & Medicaid Services (CMS).
However, in 2019, the American Medical Association (AMA) – at the request of the American Society of Plastic Surgeons (ASPS) – considered whether these flap procedures should be coded differently. As a result of that review, the AMA revised another code related to reconstruction to include DIEP and other similarly advanced flap procedures, and CMS plans to discontinue the unique codes for individual flap procedures by December 31, 2024.

“Protecting coverage to all breast reconstruction options is important to us. We know not everyone can tolerate nor want breast implants, especially considering the recent FDA safety communication alerting the public of the cancers caused by breast implants,” says BISA president Maria Gmitro.

BISA wants to protect the right to access for all types of reconstruction options. We are pleased to announce that BISA has partnered with Community Breast Reconstruction Alliance (CBRA), founded by Dr. Elisabeth Potter, a plastic surgeon in Austin, Texas. Our mission aligns with CBRA.

The Problem

DIEP flap reconstruction has been covered by insurance since 2007. The new change means that DIEP flap surgery will no longer have a unique billing code. In 2019 the Centers for Medicare & Medicaid (CMS) decided to combine all flap breast reconstruction procedures together under one code and to phase out the unique codes for individual flap procedures by December 31, 2024. This means that there will be limited access to this reconstruction option, removing a patient’s right to choose.

What Can We Do?

If CMS’s decision is not reversed soon, all commercial health insurers may stop covering DIEP flap surgery between now and next year. Join us to #reversethechange that will protect access for insurance coverage of DIEP Flap. Senator Amy Klobuchar and Congresswoman Debbie Wasserman Schultz are both breast cancer survivors, and are among those who have been calling for CMS to reverse its decision and reinstate billing code S2068.

Share with your community to help raise awareness. Follow the following social media accounts on Instagram: @cbralliance @drelisabethpotter and use the hashtag #reversethechange when you share about this issue.
If you are a patient and want to get involved, fill out the form on the CBRA website to share your story or join the Patient Advocacy Committee.
Contact CMS to ask for this change to be reversed. Contact your senators and representatives and ask them to support Congresswoman Debbie Wasserman Schultz in her efforts to reverse this change. View the sources on Dr. Potter Advocacy & CBRA Resources to learn how. There are Sample letters provided for you.
Contact your employer and ask if your insurance covers DIEP flap reconstruction and if they will pay the difference in cost if it’s not covered.
If you are a surgeon, please join the CBRA Surgeon Network.