HCPCS Code S2068: Breast reconstruction with DIEP Flap or SIEA Flap

Learn about HCPCS code S2068, which describes breast reconstruction with DIEP or SIEA flaps, including documentation and billing requirements for proper reporting.

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## **What is HCPCS code S2068?** HCPCS code S2068 refers to “Breast reconstruction with deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SIEA) flap, including microsurgical technique, when performed, unilateral.” This code describes a type of autologous breast reconstruction that uses a patient’s own abdominal tissue to recreate the breast after mastectomy. Both DIEP and SIEA flap procedures involve transferring skin and fat from the lower abdomen to the chest to form a new breast mound while preserving the abdominal muscles. The DIEP flap isolates perforator vessels that run through the rectus abdominis muscle, minimizing muscle damage, while the SIEA flap uses more superficial vessels when suitable. HCPCS S2068 is reported per breast, so bilateral reconstruction should be billed as two units or with an appropriate bilateral modifier, depending on the payer. Although many commercial insurers accept this S-code, Medicare does not reimburse S-codes. Instead, Medicare requires the use of CPT 19364 for DIEP or SIEA flap reconstruction.

## **HCPCS code S2068 documentation requirements** Accurate documentation is crucial for establishing medical necessity and ensuring compliance with payer coverage policies. Because S-codes are typically reviewed manually by commercial insurers, thorough clinical and operative documentation must accompany the claim to ensure accurate review. ### **Medical necessity and surgical indication** The medical record must confirm that the breast reconstruction was medically necessary following mastectomy or another qualifying breast surgery. Documentation should include the relevant diagnosis, such as post-mastectomy breast reconstruction, history of breast cancer or prophylactic mastectomy, and details of any previous procedures. The rationale for choosing an autologous reconstruction technique, such as the DIEP or SIEA flap, should also be clearly stated. ### **Operative report details** The operative report must provide a detailed description of the surgical technique. It should specify whether a DIEP or SIEA flap was performed, outline the tissue harvest and microvascular anastomosis steps, and document laterality (unilateral or bilateral). The report should also indicate the vessels used, describe the donor-site closure, and note any concurrent procedures such as nipple reconstruction or symmetry correction. ### **Additional documentation** Pre- and postoperative notes should describe the reconstruction plan, the flap type and donor site, and any revisions or complications. If preauthorization was obtained, it must be retained with the patient’s record. Some commercial payers may also request supporting materials such as clinical photos, pathology reports, or a physician's letter of medical necessity.

## **HCPCs code S2068 billing requirements** Billing S2068 requires awareness of payer-specific rules, as S-codes are not used for Medicare or TRICARE claims. These codes are intended for commercial insurers that maintain separate reimbursement schedules for complex autologous reconstructions. Providers should confirm each payer’s policy before claim submission. ### **Coding and claim submission** S2068 is reported for each breast reconstructed using a DIEP or SIEA flap. Bilateral procedures should be billed for two units or with a bilateral modifier, as instructed by the insurer. The diagnosis code should reflect post-mastectomy reconstruction, such as Z42.1 (Encounter for breast reconstruction following mastectomy). Operative documentation must support the type of flap performed and confirm the use of microsurgical techniques. ### **Payer and reimbursement considerations** Commercial insurers typically recognize S2068 and manually review claims for payment. CMS originally planned to sunset S2066–S2068 but reversed that decision in August 2023, allowing these codes to remain active. However, this reversal did not extend Medicare coverage to S-codes. Under Medicare rules, surgeons must bill CPT 19364 (Breast reconstruction with free flap) for DIEP or SIEA flap procedures. Medicaid programs may follow either commercial or Medicare billing policy, depending on the state. ### **Modifiers and claim details** Modifiers such as LT (left), RT (right), or 50 (bilateral) may be required to indicate laterality, depending on payer requirements. The operative report must match the modifier used. When other reconstructive services are performed during the same session, each procedure should be separately documented to support the use of multiple codes.

## **Other relevant codes** Relevant HCPCS codes related to HCPCS code S2068 for breast reconstruction procedures include: - **S2066**: Breast reconstruction with gluteal artery perforator (GAP) flap, including harvesting of the flap, microvascular transfer, closure of donor site, and shaping the flap into a breast, unilateral - **S2067**: Breast reconstruction of a single breast with "stacked" deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s), and shaping the flap into a breast, unilateral

Frequently asked questions

HCPCS code S2068 refers to breast reconstruction using a deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SIEA) flap, including microsurgical techniques, performed unilaterally. It describes an autologous reconstruction procedure in which the patient’s abdominal skin and fat are transplanted to recreate the breast after mastectomy.

No. Medicare does not reimburse S-codes, including S2068. Although CMS reversed its plan to retire S2066–S2068 in August 2023, keeping these codes active, they remain non-billable under Medicare. DIEP or SIEA flap reconstruction for Medicare patients must be billed with CPT 19364 instead.

Perforator flap surgery is a microsurgical technique that transfers skin and fat from one body area to another while preserving the underlying muscles. By using small blood vessels, or perforators, to maintain blood supply, this approach minimizes muscle injury and promotes faster recovery.