2025 HCPCS code S2067
(Active) Effective Date: N/A Revision Date: N/A Surgical - Breast Reconstruction Miscellaneous Provider Services and Supplies Feed
Breast reconstruction of a single breast using stacked DIEP or GAP flaps, including flap harvesting, microvascular transfer, donor site closure, and shaping.
Modifiers may apply depending on the specific circumstances of the procedure. Consult the most recent modifier guidelines.
Medical necessity for breast reconstruction is typically established based on the patient's medical history (e.g., mastectomy due to cancer, trauma, or congenital anomaly), and the surgeon's determination that reconstruction is appropriate for the patient's physical and psychological well-being.Documentation supporting medical necessity must be present in the medical record.
The clinical responsibility lies with the surgeon performing the breast reconstruction. This includes pre-operative planning, surgical procedure (flap harvesting, microvascular anastomosis, donor site closure, and breast shaping), and post-operative care.
In simple words: This code describes a type of breast reconstruction surgery where the surgeon uses tissue from the lower belly or buttocks to rebuild a breast after it has been removed.The surgeon moves the tissue, connects its blood supply, closes the area where the tissue was taken, and shapes the new breast.
This HCPCS code encompasses the surgical procedure of unilateral breast reconstruction using stacked deep inferior epigastric perforator (DIEP) flaps and/or gluteal artery perforator (GAP) flaps.The procedure includes harvesting the flap(s) from the lower abdomen or buttocks, performing microvascular transfer to connect the flap's blood supply, closing the donor site(s), and meticulously shaping the flap(s) to recreate the breast contour.The procedure is performed on a single breast.
Example 1: A patient undergoes a mastectomy for breast cancer.Following the mastectomy, she opts for breast reconstruction using a DIEP flap. Code S2067 would be used to bill for this procedure., A patient has undergone a prior mastectomy and desires breast reconstruction. The surgeon determines that a GAP flap is the most appropriate approach, necessitating the use of code S2067., A patient requires breast reconstruction using a combination of DIEP and GAP flaps to achieve optimal aesthetic results. In this scenario, code S2067 would accurately reflect the complexity of the procedure.
Complete medical record including pre-operative diagnosis, operative report detailing the specific type of flap(s) used, microvascular anastomosis details, and post-operative recovery.Imaging studies (e.g., CT scans, Doppler studies) to assess vascularity should also be documented.
** This code is not reimbursable by Medicare.Check with individual payers for reimbursement policies.Always ensure accurate documentation to support medical necessity and proper coding.
- Payment Status: Not payable by Medicare
- Modifier TC rule: The application of a Technical Component (TC) modifier would depend on the specific billing practices and payer guidelines. Consult your payer for specific guidance.
- Specialties:Plastic Surgery, Surgical Oncology
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient