Dr. Valerie Gorman from Texas Breast Center Discusses the Upcoming Change in Insurance Coverage for DIEP Flap Procedures

Waxahachie, Texas -

Texas Breast Center, a highly rated breast surgery practice based in Waxahachie, TX, is alerting patients across the country about a recently proposed change to insurance coverage for DIEP flap procedures.

DIEP flap surgery, a method of breast reconstruction, involves transferring fat, skin, and blood vessels from the abdominal wall to the chest to reconstruct the breast. DIEP stands for the deep inferior epigastric perforator artery, which runs through the abdomen. Since the DIEP flap is regarded as a muscle-sparing type of flap, no muscle is harvested, and most women have a shorter recovery time following the procedure. There is also a reduced chance of losing abdominal muscular strength compared to traditional TRAM flap procedures.

Dr. Valerie Gorman, founder, and general surgeon at Texas Breast Center, details the federal modifications that could change the way Americans pay for DIEP flap procedures by saying, “Today, flap procedures have unique billing codes. So, the older, less sophisticated TRAM flap surgery is billed differently than the DIEP flap procedure. This works great as the former is almost 70 to 90% cheaper than the latter, more advanced, procedure. However, following the decision made by the CMS (Centers for Medicare & Medicaid Services) in 2019, individual procedure-specific codes will be phased out by the end of 2024. What this means for patients is that insurance companies will no longer be required to pay the full cost of the DIEP flap surgery and can get away with covering just the cost of the TRAM flap procedure.”

When the change is finally implemented, healthcare professionals will no longer be able to offer DIEP flap surgery, leaving patients with two options, either paying the out-of-pocket expenses for the procedure (which can cost over $50,000) or settling for less-than-ideal treatment options. In fact, several health insurance providers have already stopped covering the DIEP flap procedure even before the changes take effect next year.

“It is a troubling change that severely limits the treatment options that breast cancer survivors have access to,” Dr. Valerie says. “It is true that the Women’s Health and Cancer Rights Act of 1998 and Affordable Care Act do offer certain protections to women who are undergoing breast cancer surgery. However, since those regulations do not outline the specific procedures of breast reconstruction which must be covered, the change will still affect patients’ ability to choose the surgery that is right for them.”

In the article published on the center’s website, Dr. Valerie offers advice on what patients can do to protect their rights. First, affected breast cancer patients can get in touch with their senator and local representative and ask them to lobby CMS to reverse the changes made to the descriptor of CPT code 19364 and restore billing codes S2068 (for DIEP flap surgery), S2066 (for SGAP surgery), and S2067 (for stacked flap surgery). Those who have had or are considering DIEP flap reconstruction, can write about their experience and explain what access to the procedure means to them.

“A breast cancer diagnosis is a stressful time,” Dr. Valerie says, “and the elimination of separate billing codes is going to compound the anxiety that patients around the country, who are dealing with its life-changing ramifications, go through. There are some financial assistance programs that you could reach out to if the expenses associated with DIEP flap surgery are not covered by your individual health policy. If you need further help, you can contact Texas Breast Center where we offer an advanced, personalized, and targeted treatment approach.”

Valerie J. Gorman, MD, FACS, is a breast surgeon who specializes in surgical oncology and surgical diseases of the breast. She is Board Certified by the American Board of Surgery and serves as Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center – Waxahachie.

For more information about breast cancer treatment, breast cancer surgery options, and the compassionate care offered by Dr. Gorman at Texas Breast Center, readers can visit the center’s website or call to schedule a consultation.