Summary & Overview
HCPCS S2067: Unilateral Stacked DIEP/GAP Flap Breast Reconstruction
HCPCS Level II code S2067 represents unilateral autologous breast reconstruction using "stacked" deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s), encompassing flap harvest, microvascular transfer, donor-site closure, and shaping of the reconstructed breast. This complex microsurgical procedure is a critical option for patients seeking autologous reconstruction after mastectomy and has implications for surgical capacity, payer coverage policies, and resource utilization nationwide.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes coverage and coding implications across these major payers, highlighting typical sites of service, service line classification, and common procedural context for billing and authorization.
Readers will learn what S2067 denotes clinically and operationally, where the procedure is typically performed, and what national payers commonly consider in coverage and claims processing. The report provides benchmarks and policy-relevant observations, clarifies clinical context for utilization, and identifies areas where data was not provided. Data not available in the input: associated taxonomies, specific ICD-10 diagnoses, related codes, and payer-specific reimbursement rates.
Billing Code Overview
HCPCS Level II code S2067 describes breast reconstruction of a single breast using "stacked" deep inferior epigastric perforator (DIEP) flap(s) and/or gluteal artery perforator (GAP) flap(s). The procedure includes harvesting of the flap(s), microvascular transfer, closure of donor site(s), and shaping the flap into a unilateral breast.
Service Type: Autologous microvascular breast reconstruction (unilateral), reconstructive plastic surgery
Typical Site of Service: Inpatient hospital or ambulatory surgery center with microsurgical capabilities; operative suite for major reconstructive surgery
Clinical & Coding Specifications
Clinical Context
A 48-year-old woman with a history of left-sided mastectomy for invasive ductal carcinoma elects delayed autologous reconstruction. She has adequate abdominal and/or gluteal donor tissue but requires increased volume and projection; the reconstructive surgeon plans a unilateral “stacked” deep inferior epigastric perforator (DIEP) flap with an additional DIEP or gluteal artery perforator (GAP) flap to achieve symmetry. Preoperative workup includes oncologic clearance, vascular imaging (CT angiography) of donor sites, and optimization of comorbidities (smoking cessation, glycemic control). The operative workflow: flap harvest from donor site(s) (abdominal and/or gluteal), microvascular anastomosis to recipient chest vessels, shaping and inset of the stacked flap construct to the mastectomy site, primary closure of donor sites, and intraoperative perfusion assessment. Postoperative care includes microsurgical flap monitoring in PACU/ICU, anticoagulation per protocol, wound care, and staged adjustments if needed. Typical site of service is an inpatient hospital operating room with a post-anesthesia care unit or dedicated microsurgery recovery/ICU bed for flap monitoring. Service type: complex unilateral autologous breast reconstruction with microvascular free flap(s) using stacked perforator flaps.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the reconstruction is performed on the left breast. |