Please remember that EmblemHealth and ConnectiCare do not accept most HCPCS codes on claims for medical, surgical, and/or diagnostic procedures for our commercial and Medicaid plans. Instead, providers should submit claims with the appropriate CPT code(s) that accurately identify the procedure(s) and/or service(s) performed.
Free Flap Breast Reconstruction
EmblemHealth and ConnectiCare require providers to submit CPT code 19364 to report breast reconstruction via a free flap. We do not accept HCPCS Level II S2066-S2068. To help with proper coding, we have updated our reimbursement policy to include a clarifying example regarding Free Flap Breast Reconstruction (HCPCS codes S2066-S2068).
The history behind the codes explains why we need our providers to use CPT code 19364. At a time when there was no national code to adequately describe free flap breast reconstruction, the Blue Cross/Blue Shield association developed the temporary HCPCS Level II codes S2066-S2068. Since the development of the temporary “S” codes, the AMA updated CPT code 19364 to describe free flap breast reconstruction via the techniques described in S2066-S2068 (GAP, DIEP, and SIEA flaps). Therefore, EmblemHealth and ConnectiCare do not accept HCPCS Level II S2066-S2068 to report breast reconstruction via a free flap and require providers to submit CPT code 19364 instead.