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S.1217 - Breast Cancer Patient Equity Act
A bill to amend title XVIII of the Social Security Act to provide coverage for custom fabricated breast prostheses following a mastectomy.
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SECTION 1. SHORT TITLE; FINDINGS.
(5) A woman suffering from the loss of her breast may not be a candidate for surgical breast reconstruction or may choose not to undergo additional surgery if there were a viable, less costly, less invasive option available.CommentsClose CommentsPermalink
(6) The results of breast reconstruction surgery can vary and, as with any surgical procedure, there are inherent risks associated with such surgery. Additionally, reconstruction of the breast using implants can impose increased risks and costs due to the eventual need for implant replacement surgery.CommentsClose CommentsPermalink
(7) The number of women choosing to undergo surgical breast reconstruction continues to increase, as many women lack the viable option of custom fabricated prosthetic breasts to restore the lost breast.CommentsClose CommentsPermalink
(8) Both older women and minority women are less likely to be offered or undergo surgical breast reconstruction and are disproportionately disadvantaged by a lack of access to the option of custom fabricated prosthetic breasts.CommentsClose CommentsPermalink
(9) Currently, the Medicare program provides coverage and reimbursement for custom fabricated prostheses for any body part, with the exception of breasts, that has been lost.CommentsClose CommentsPermalink
(10) Following passage of the Women’s Health and Cancer Rights Act of 1998 (
(11) While the Medicare program recognizes custom fabricated breast prostheses as a discrete device and valid treatment option, having assigned a billing code for such option under the Healthcare Common Procedure Coding System (‘HCPCS’) and setting a maximum allowable fee, Medicare does not provide reimbursement and denies claims as ‘not medically necessary’. Medicare does provide reimbursement, however, for more costly surgical breast reconstruction.CommentsClose CommentsPermalink
(12) Due to the fact that the Medicare program does not provide reimbursement for custom fabricated breast prostheses, many private insurance companies have also begun to limit their reimbursement for them.CommentsClose CommentsPermalink