Will New Medical Billing Changes Jeopardize My DIEP Flap Insurance Coverage?

Closeup midsection of female fitness freak measuring her breasts The last thing you want to worry about when battling breast cancer is whether your insurance will cover the lifesaving procedures you need. Unfortunately, a change by the Centers for Medicare & Medicaid Services (CMS) has many patients worried about just that. 

In 2019, CMS announced an adjustment to medical billing codes that combines all flap reconstruction procedures under one code. To find out what that could mean for your breast reconstruction, read on or call 303-706-1100 to book a consultation at The Breast Center Park Meadows Cosmetic Surgery.

What’s Changing with DIEP Flap Insurance Coverage?

The recent CMS changes to medical billing codes could affect DIEP flap reconstruction coverage by grouping flap procedures under a single code. This means TRAM flap surgery will be billed under the same code as a DIEP flap procedure. While TRAM flap procedures are an effective option for some patients, they’re also older, more invasive, and about 70 percent to 90 percent less expensive than DIEP flap. This means there could be difficulties in getting certain insurers to reimburse DIEP flap procedures.

Coding changes are set to go into effect in December 2024, but this issue has been on The Breast Center Park Meadows Cosmetic Surgery’s radar for a while. At the time of writing, this CPT code service change doesn’t impact our patients. Our providers are experienced in navigating insurance plans and billing to get you the most coverage possible. We’ll continue to keep an eye on how CMS changes impact patients in 2024. Our patient navigator is also happy to answer any insurance coverage and financing questions as we plan your reconstruction.

Can I Still Get Insurance Coverage for My DIEP Flap Surgery?

The Women’s Health and Cancer Rights Act of 1998 (WHCRA) requires insurance providers offering mastectomy coverage to also provide breast reconstruction coverage. Unfortunately, WHCRA doesn’t specify that insurers need to cover autologous breast reconstruction techniques like DIEP flap. Even before the recent CMS changes, many patients had difficulty getting reimbursement for more advanced types of reconstruction or surgery with an out-of-network provider. The upcoming code changes mean some insurers will likely limit the procedures they cover or cut reimbursement. 

As leading DIEP flap surgeons in the Denver area, the providers at The Breast Center Park Meadows Cosmetic Surgery aren’t strangers to navigating tricky insurance issues. If you’re confused about what your policy covers, our team can clarify and will factor your coverage into your breast reconstruction plan.

Schedule Your Breast Reconstruction Consultation

At The Breast Center Park Meadows Cosmetic Surgery, board-certified plastic surgeons Dr. Jeremy Williams and Dr. Christopher Williams have extensive expertise in implant-based and autologous breast reconstruction. Call 303-706-1100 to discuss your reconstruction options and insurance coverage with our warm and welcoming team in Lone Tree, Colorado.

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