Advocating for breast cancer reconstructive surgery access in the United States

Maita, Karla C.; Ávila, Francisco R.; Torres, Ricardo; Garcia, John; Sario, Gioacchino D. De; Borna, Sahar; Forte, Antonio J.; Ho, Olivia A.

doi:10.1057/s41271-023-00434-5

Cited by 1 publication

(2 citation statements)

References 7 publications

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“…The Women's Health and Cancer Rights Act (WHCRA) of 1998 mandated private and group insurance coverage for all breast reconstruction stages, including autologous techniques, when mastectomy was also covered (Xie et al, 2015). A pivotal change occurred in 2022, however, when the Medicare & Medicaid Services (CMS) declared that as of December 2024, billing codes for free flap autologous breast reconstructions would be amalgamated under a single CPT code with concomitant elimination of reimbursement by S codes (Maita et al, 2023; Uscher, 2023). This meant that diverse microsurgical procedures, irrespective of technique or expertise, would fall under a single billing category (Uscher, 2023).…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, the HCPCS Level II codes, namely S2066, S2067, and S2068, serve to cover autologous reconstruction procedures, such as DIEP, GAP, and SIEA flaps. (Maita et al, 2023; Uscher, 2023) The specificity of these codes addresses a gap in the general CPT coding system, ensuring that complex microsurgical techniques are accurately billed and reimbursed (Maita et al, 2023; Uscher, 2023). This not only facilitates financial transactions but also guarantees that patients have access to a wide spectrum of reconstructive options post‐mastectomy.…”

Section: Introductionmentioning

confidence: 99%

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The value of microvascular breast reconstruction: Cost equivalence of TRAM and DIEP flaps implications in the era of CMS reforms

Foppiani,

Hernandez Alvarez,

Kim

et al. 2024

Microsurgery

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BackgroundRecent CMS billing changes have raised concerns about insurance coverage for deep inferior epigastric perforator (DIEP) flap breast reconstruction. This study compared the costs and utilization of transverse rectus abdominis myocutaneous (TRAM), DIEP, and latissimus dorsi (LD) flaps in breast reconstruction.MethodThe study utilized the National Inpatient Sample database to identify female patients who underwent DIEP, TRAM, and LD flap procedures from 2016 to 2019. Key data such as patient demographics, length of stay, complications, and costs (adjusted to 2021 USD) were analyzed, focusing on differences across the flap types.ResultsA total of 17,770 weighted patient encounters were identified, with the median age being 51. The majority underwent DIEP flaps (73.5%), followed by TRAM (14.2%) and LD (12.1%) flaps. The findings revealed that DIEP and TRAM flaps had a similar length of stay (LOS), while LD flaps typically had a shorter LOS. The total hospital charges to costs using cost‐to‐charge ratio were also comparable between DIEP and TRAM flaps, whereas LD flaps were significantly less expensive. Factors such as income quartile, primary payer of hospitalization, and geographic region significantly influenced flap choice.ConclusionThe study's results appear to contradict the prevailing notion that TRAM flaps are more cost‐effective than DIEP flaps. The total hospital charges to costs using cost‐to‐charge ratio and hospital stays associated with TRAM and DIEP flaps were found to be similar. These findings suggest that changes in the insurance landscape, which may limit the use of DIEP flaps, could undermine patient autonomy while not necessarily reducing healthcare costs. Such policy shifts could favor less costly options like the LD flap, potentially altering the landscape of microvascular breast reconstruction.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%