OBR OncologyBreast Reconstruction Coding Change Called “Practice-Ending”

How will the elimination of the S2068 billing code impact your breast reconstruction practice and your patients’ access to quality care?

Physicians nationwide are expressing major concerns over the upcoming changes by the Centers for Medicare and Medicaid Services (CMS), which, they warn, could lead to a dramatic reduction in breast reconstruction surgeries using the deep inferior epigastric perforator (DIEP) flap method due to significant pay cuts.

Key Points:

• CMS plans to eliminate several “S” codes in 2024, including S2068, which is used for billing DIEP flap breast reconstruction surgeries.
• The discontinuation of S2068 forces providers to use CPT code 19364, which reimburses 50%-70% less than the current S2068 rate.
• The coding change is expected to deter many reconstructive surgeons from performing DIEP due to inadequate compensation for their time, skill, and overhead costs.
• Breast cancer patients would then have to pay out of pocket, potentially upwards of $50,000 for the procedure or travel to seek the services of the few remaining providers offering DIEP.

Additional Points:

• Many advocacy groups have written to CMS urging the reversal of this decision, but the agency’s response remains uncertain.
• Elisabeth Potter, MD, a specialist in DIEP flap breast reconstructions, predicts that the change could be “practice-ending” for many surgeons.
• Shelley Fuld Nasso, CEO of the National Coalition for Cancer Survivorship, has voiced concerns about the increasing disparities in access to care as a result of this change.

Conclusion:

• The anticipated CMS coding changes could drastically affect the field of breast reconstruction surgeries, potentially leading to a decrease in the number of surgeons willing to perform the clinically superior DIEP flap procedures and thus increasing health disparities among breast cancer survivors.

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