Surgery Code S2068

In 1998, the Women's Health and Cancer Rights Act (WHCRA) was enacted to protect the rights of cancer patients during their recovery process. According to the WHCRA, health insurance plans that cover mastectomies must provide coverage for reconstructive surgery, prostheses, and other post-mastectomy procedures. This coverage includes all stages of breast reconstruction on the affected breast, surgery and reconstruction of the other breast to achieve a symmetrical appearance, and treatment of physical complications at all stages of mastectomy, such as lymphedema.

How Recent Billing Code Updates Limit Breast Cancer Care

Mastectomies and lumpectomies can have a profound impact on a patient's self-image, self-esteem, and overall quality of life. Breast reconstruction and other post-mastectomy procedures are crucial in helping cancer patients navigate the road to recovery, regain their confidence, and cope with psychosocial challenges. 

The recent removal of the S2068 billing code by the Centers for Medicare & Medicaid Services (CMS) poses a threat to breast cancer patients and exacerbates disparities in the quality of breast cancer care. The S2068 code is used for prepectoral breast reconstruction procedures, such as DIEP Flap and GAP Flap surgery, which are less invasive and result in more natural-looking and feeling breast reconstructions with reduced pain and complications. Without this code, it may be more difficult for patients to access these specific surgery options unless they are able to pay for them out-of-pocket.

Be Aware:

Effective December 31, 2024, S-codes will be fully phased out and replaced with a catch-all billing code.

These prepectoral procedures will be billed under the same code used for the TRAM flap surgery, a significantly cheaper, dated, less advanced, and less common procedure associated with more long-term complications. This change will make it difficult and even impossible for doctors to bill insurance companies for prepectoral surgeries, and insurance companies may deny or minimize coverage for these procedures. As a result, they may not be offered by doctors as options and patients may not be able to have access to the most appropriate surgeries for them. Unfortunately, some insurance providers have already declared their intent to stop covering DIEP flap surgery in response to this change, and more may follow suit.

Breast cancer advocacy groups, healthcare providers, and patients have criticized the removal of the S2068 code, stating that it is a critical component of breast cancer treatment and should be reinstated. This situation highlights the importance of ensuring that all cancer patients, regardless of their financial situation or location, have equal access to necessary treatments and procedures to recover and improve their quality of life. It is crucial to take action to reverse this change and ensure that breast cancer patients have equal access to the necessary procedures to recover and improve their quality of life.

Get Informed: 

Resources for learning more about reconstruction surgery code S2068

• CMS website: The Centers for Medicare & Medicaid Services (CMS) website provides information on the Medicare fee schedule and updates to billing codes, including Surgery Code S2068.
• American Society of Plastic Surgeons (ASPS): The ASPS is a professional organization for plastic surgeons and offers resources on breast reconstruction surgery, including information on Surgery Code S2068.
• National Comprehensive Cancer Network (NCCN): The NCCN is a nonprofit organization that provides guidelines for cancer treatment and management. Their website provides information on breast cancer treatment and breast reconstruction options, including Surgery Code S2068.
• Breast cancer advocacy organizations: There are several breast cancer advocacy organizations, such as Susan G. Komen and BreastCancer.org, that provide information and resources on breast cancer treatment, including breast reconstruction surgery and Surgery Code S2068.
• Healthcare providers: Healthcare providers, including plastic surgeons and breast surgeons, can provide information and resources on breast reconstruction surgery and Surgery Code S2068. They can also help patients understand their treatment options and navigate the billing and reimbursement process.

Take Action: 

Use your voice and join us in the fight to preserve access to modern breast reconstruction. 

Step 1: Petition to CMS to reinstate breast reconstruction surgery code S2068.

We, the undersigned, are writing to petition for the reinstatement of Breast Reconstruction Surgery Code S2068. We believe that this code is critical for ensuring that women have access to the best possible care and treatment options after mastectomy.

Breast reconstruction surgery is an important component of breast cancer treatment, and can significantly improve a patient's physical and emotional well-being. However, the removal of code S2068 has created significant challenges for both patients and healthcare providers.

Without this code, providers are unable to bill for certain types of breast reconstruction procedures, including prepectoral breast reconstruction. This procedure involves placing the breast implant above the chest muscle, rather than under it, resulting in a more natural look and feel. Without adequate reimbursement, healthcare providers may be less likely to offer this procedure to patients, limiting their treatment options.

Furthermore, the removal of this code creates financial barriers for patients seeking breast reconstruction surgery. Many patients rely on Medicare and Medicaid to cover the cost of their treatment, and the lack of appropriate billing codes can make it more difficult for them to access the care they need.

We believe that reinstating code S2068 is critical for ensuring that all women have access to the full range of breast reconstruction treatment options, regardless of their financial situation. We urge the CMS to take action on this issue and work to restore this important billing code.

Step 2: Write to your US Senators and ask them to defend patients’ access to DIEP flap breast reconstruction. 

Use the links below to contact your senator or representative. For your convenience, we have written a sample letter that you can use. We also encourage you to share your own personal story. 

Sample Letter

Our Promise to You:

The Advanced Reconstructive Surgery Alliance (ARSA) will continue to serve the needs of patients – regardless of coding changes. We understand that access to this code can make a significant difference in the quality of life for patients and their families, and we are dedicated to ensuring that it remains available to those who need it.