After Backlash, Feds Cancel Plan That Risked Limiting Breast Reconstruction Options

by | Aug 23, 2023 | Health

Federal regulators have abandoned a plan that physicians, patients, and advocacy groups for breast cancer patients feared would limit women’s options for reconstructive surgery.

The controversy centered on how doctors are paid for a type of breast reconstruction known as DIEP flap, in which skin, fat, and blood vessels are harvested from a woman’s abdomen to create a new breast.

Last year, the Centers for Medicare & Medicaid Services decided to eliminate a trio of medical billing codes for breast reconstructive surgery that enabled doctors to collect much more money for DIEP flap operations than for simpler types of breast reconstruction. Some plastic surgeons said the government’s move would limit access and make DIEP flaps available only to those who could afford to pay tens of thousands of dollars out-of-pocket.

Through its coding decisions, the federal government can influence the medical options available to patients, even those with private insurance.

In an Aug. 22 memo, CMS wrote that it received a “substantial number of responses” verbally and in writing asking regulators to keep the “S” billing codes that reimburse doctors more for the surgery. “The majority of the commenters feel their accessibility will be, or has already been, impacted by the decision to eliminate the S codes,” the agency wrote in reversing its earlier plan.

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Supporters praised CMS’ latest action. “I’m so grateful to CMS for this decision that is really meaningful,” Elisabeth Potter, a plastic surgeon who specializes in DIEP flap surgeries, said in a social media post.

The agency’s announcement came after it convened a public hearing in June, during which several patient …

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