Treatment has advanced, but reimbursement rates have stood still... Breast cancer society: “The marker reimbursement system must change”

[Financial News] Even when preoperative chemotherapy works so well that a tumor is no longer visible on imaging, surgery is still necessary. A breast tissue marker, just a few millimeters in size, indicates where the vanished tumor was.
However, concerns have been raised that these markers fall into a blind spot in health insurance reimbursement. The Korean Breast Cancer Society said on the 10th that the clinical need for breast tissue markers—which mark the locations of breast lesions and metastatic lymph nodes before neoadjuvant chemotherapy—is growing, but the current health insurance reimbursement system does not adequately reflect changes in clinical practice. The society proposed billing separately for the marker material under the existing localization procedure or, if that is not feasible, creating a separate procedure code for marker insertion.
Neoadjuvant chemotherapy is treatment given before surgery to shrink a tumor and minimize the extent of surgery on the breast and axillary lymph nodes. Patients with large tumors or lymph node metastases, particularly those with triple-negative or HER2-positive breast cancer, often respond well to neoadjuvant chemotherapy, and their lesions may become very small or disappear on preoperative imaging.
Even when the response to treatment is good, surgery and pathological evaluation are still necessary. If the location of the primary lesion is marked before chemotherapy, doctors can accurately identify where it was after treatment, plan the extent of surgery, and evaluate the excised tissue pathologically.
A marker is a clip-like device inserted into the tumor site under imaging guidance, such as ultrasound, before chemotherapy begins. It is made of materials suitable for implantation in the human body, such as titanium, and remains in place even if the tumor shrinks or disappears, serving as a reference point for determining the extent of surgery.
Markers are also inserted into axillary lymph nodes confirmed to have metastases. Marking metastatic lymph nodes before treatment makes it possible to locate and remove them accurately afterward and assess whether cancer cells remain, helping reduce false-negative results. When necessary, selectively removing and evaluating only the marked lymph nodes and sentinel lymph nodes can avoid unnecessary axillary lymph node dissection and reduce the risk of postoperative complications such as lymphedema, limited shoulder movement, and nerve damage.
Heo Ho, director of insurance affairs at the Korean Breast Cancer Society and a professor of surgery at National Health Insurance Service Ilsan Hospital, explained, “When a lesion has shrunk significantly or is no longer visible on imaging after neoadjuvant chemotherapy, it is important to accurately identify where it was before treatment,” adding, “Markers preserve the locations of breast lesions and metastatic lymph nodes, and are an important tool for ensuring accurate surgery and pathological evaluation after treatment.”
The problem lies in the reimbursement system. There is currently no separate procedure fee for breast tissue marker insertion, so it is reimbursed at the rate for the existing “localization of nonpalpable breast lesions” procedure. Although the two procedures differ in timing and purpose, there is no system to reimburse them separately, and the cost of the marker material cannot be billed separately either, making appropriate reimbursement in clinical practice difficult.
To address this, the society proposed billing for marker materials separately from the procedure fee for localization or, alternatively, establishing a separate procedure code for marker insertion before neoadjuvant chemotherapy, distinct from the localization procedure. The society said that the health insurance reimbursement system should also reflect changes in clinical practice brought about by advances in neoadjuvant chemotherapy.
The society emphasized that these institutional improvements are meaningful not merely as a way to cover costs for specific medical institutions, but because they would lay the groundwork for ensuring that patients receiving neoadjuvant chemotherapy can reliably access the care they need, regardless of the circumstances of the medical institution.
Lee Jeong-eon, president of the Korean Breast Cancer Society, said, “As effective anticancer drugs and precision treatment strategies advance, more patients are seeing their lesions shrink substantially or disappear after neoadjuvant chemotherapy,” adding, “For patients to undergo surgery safely and receive optimal treatment, the reimbursement system must reflect clinical realities, and institutional improvements must be made as well.” 

[email protected] Jung Myung-jin, Medical Specialist Reporter