EXTERNAL BREAST PROSTHETICS

Coverage Guidelines

A breast prosthesis is covered for a patient who has had a mastectomy. 

 The Medicare program will pay for only one breast prosthesis per side for the useful lifetime of the prosthesis. Two prostheses, one per side, are allowed for those persons who have had bilateral mastectomies.

A mastectomy bra is covered for a patient who has a covered mastectomy form or silicone breast prosthesis when the pocket of the bra is used to hold the form/prosthesis.