S2067 Breast "stacked" diep/gapBreast 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
Status I: not valid for Medicare (Medicare uses another code).
6 of 6 payer prior-auth lists that name S2067 require prior authorization or set conditions: Aetna, Humana, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Aetna | Commercial | All | prior auth required | site of care: procedure and site of service review | Oct 1, 2026 | Participating provider precertification list for Aetna® |
| Aetna | Medicare Advantage | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| Humana | Humana Healthy Horizons | OK | prior auth required | Jan 1, 2027 | Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list | |
| UnitedHealthcare Community Plan | Indiana Hoosier Care Connect | IN | prior auth required | Oct 1, 2026 | Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Indiana PathWays for Aging (MLTSS) | IN | prior auth under conditions | PA not required with dx C50.019, C50.011, C50.012, C50.111, C50.112, C50.119 (+67 more) | Oct 1, 2026 | Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026 |
S2067 appears in 19 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, Capital Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Breast Reconstructive Surgery (0185) | covered if criteria are met | Apr 22, 2026 | payer document |
| Aetna | Bupivacaine Liposome (Exparel) (0941) | listed, no stance | Jul 30, 2026 | payer document |
| Aetna | Gender Affirming Surgery (0615) | covered if criteria are met | Sep 8, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Breast Reconstruction Following Mastectomy (L.7.01.424) | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Reconstructive Breast Surgery (428) | listed, no stance | payer document | |
| Blue Shield of California | Reconstructive Breast Surgery/Management of Breast Implants (7.01.22) | listed, no stance | payer document | |
| Capital Blue Cross | Reconstructive Breast Surgery Including Management of Breast Implants, External Breast Prosthesis and Post Mastectomy Bras (MP 1.103) Procedure codes | covered if criteria are met | Apr 1, 2026 | payer document |
| Regence | Reconstructive Breast Surgery/Mastopexy, and Management of Breast Implants (Surgery 40) | listed, no stance | Oct 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (MP.003.29) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Breast Reconstruction (CS011.W) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Idaho Only) (CS011ID.C) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Indiana Only) (CS011IN.10) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Kansas Only) (CS011KS.02) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Kentucky Only) (CS011KY.13) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Nebraska Only) (CS011NE.V) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (for New Mexico Only) (CS011NM.C) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Ohio Only) (CS011OH.C) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Pennsylvania Only) (CS011PA.W) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Breast Reconstruction (for Tennessee Only) (CS011TN.T) | listed, no stance | Nov 1, 2025 | payer document |
Prior authorization required or conditional in CO, IN, WA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.