2025 HCPCS code S2068
(Active (as of December 3, 2024)) Effective Date: N/A Revision Date: N/A Deletion Date: Dec 31, 2024 Surgery - Breast Reconstruction Miscellaneous Provider Services and Supplies Feed
Breast reconstruction using a DIEP or SIEA flap, including flap harvesting, microvascular transfer, donor site closure, and breast shaping.
Modifiers may apply depending on the circumstances of the procedure, such as the use of anesthesia or the location of the service. Always refer to payer-specific guidelines.
Medical necessity is established by the need for breast reconstruction following a mastectomy due to cancer or other medical conditions. Documentation must support the appropriateness of the chosen flap and the overall surgical plan. The need for the surgery should be clearly documented.
The surgical responsibility includes pre-operative planning, surgical procedure, post-operative care, and patient education
In simple words: This code covers a type of breast reconstruction surgery where the surgeon uses tissue from the lower belly to rebuild the breast.It involves connecting blood vessels, closing the belly incision, and shaping the new breast.
This HCPCS code encompasses breast reconstruction utilizing either a deep inferior epigastric perforator (DIEP) flap or a superficial inferior epigastric artery (SIEA) flap.The procedure involves harvesting the chosen flap from the lower abdomen, performing microvascular transfer to connect the flap's blood supply to the recipient site, meticulously closing the donor site, and skillfully shaping the flap to create a natural-looking breast contour. The procedure is performed unilaterally (on one side only).
Example 1: A 45-year-old female patient undergoes a mastectomy for breast cancer.Post-mastectomy, she elects for breast reconstruction using a DIEP flap.Code S2068 would be used to bill for this procedure., A 50-year-old female patient chooses a SIEA flap breast reconstruction following a unilateral mastectomy. Code S2068 would accurately represent this surgical procedure., A 60-year-old female patient has undergone a prior mastectomy and now desires breast reconstruction. She is a suitable candidate for a DIEP flap reconstruction; therefore, code S2068 is appropriate.
Complete surgical notes documenting the type of flap used (DIEP or SIEA), details of the microvascular anastomosis,donor site closure technique, and intraoperative and post-operative complications (if any).Preoperative imaging (e.g., MRI, CT scan), pathology reports confirming the diagnosis, and consent forms are also required.
** This code is not reimbursable by Medicare. Payer-specific policies should be reviewed for coverage and reimbursement. The use of S-codes is temporary and they will eventually be phased out.Always confirm current payer policies for reimbursement before billing.
- RVU: Not applicable to HCPCS codes; reimbursement varies by payer.
- Global Days: Global surgical period details not specified, refer to payer guidelines.
- Payment Status: Active (as of December 3, 2024) but not payable by Medicare
- Modifier TC rule: The TC modifier is not applicable to this code, since the entire procedure is performed by the surgeon.
- Fee Schedule: Fee schedules vary significantly by payer and geographic location.Historical data is not consistently tracked for HCPCS codes.
- Specialties:Plastic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department