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.
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.
The DIEP flap procedure has potential benefits over implants and operations that take muscle from the abdomen. For example, although implants are less costly and less time-intensive to perform, they generally need to be replaced every 10 years or so. But DIEP flap surgery is also more expensive. If patients go outside an insurance network for the operation, it can cost more than $50,000.
CMS initially decided the codes would expire at the end of 2024; however, even with the delayed effective date, physicians said, the decision was starting to hinder access to DIEP flap surgery and create anxiety for patients. At least two major insurance companies told doctors they would no longer reimburse them under the higher-paying codes.
Belgique Dernières Nouvelles, Belgique Actualités
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