Access to DIEP flap breast reconstruction threatened by insurance coding change

DIEP flap reconstruction is a modern microsurgical breast reconstruction technique that rebuilds a patient's breast with natural tissue while preserving their strength. DIEP flap breast reconstruction, a specialized reconstruction surgery, is preferred by some patients because it 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 which has a limited lifespan and will require more surgeries. Implants also carry risks associated with cancer, breast implant illness, and malfunction. People considering breast reconstruction have varied circumstances and unique personal risk tolerances. Every person affected by breast cancer should know their options and choose what is best for them in consultation with their doctors. 

DIEP flap surgery is different from other flap reconstruction procedures 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. DIEP flap's clear advantages make it an important option for any person to consider when seeking breast reconstruction. 

Despite the clear advantages and unique surgical attributes associated with DIEP flap breast reconstruction, a recent CMS coding change equated DIEP flap surgery with other less advanced flap reconstruction surgeries. This coding change will immediately decrease reimbursement for DIEP flap reconstruction to the rate of more basic flap procedures. This payment reduction threatens to decrease access to DIEP flap reconstruction by reducing the number of surgeons offering breast reconstruction through insurance. 

These proposed coding changes, and lowered reimbursements, are already incentivizing some providers to accept only cash payments for this procedure. In accordance with this coding change, some insurance companies have announced they will stop paying appropriate rates for the more advanced DIEP flap surgery in 2023. As a result, women who don't have the means to pay for this procedure upfront will lose out on this valuable reconstruction option. 

We exist to protect people's access to breast reconstruction through insurance in the communities where they live. Learning from the experiences of patients, providers, and stakeholders, we collaborate to raise awareness of challenges affecting breast reconstruction. Joining forces, we empower the collective community to know better and do better. 

In the short term, we seek a collaborative solution that preserves access for patients by reversing the coding change to avoid patient harm. 

In the long term, we seek collaborative efforts to prevent future reduction in access and expand the use of value based analyses in protecting the evolving field of modern breast reconstruction.