Breast prostheses
Medicare Coverage Information
Overview
Medicare provides coverage for breast prostheses for patients who have undergone a mastectomy. These prosthetic devices are considered essential medical equipment to help restore a patient's physical appearance and confidence after breast cancer treatment.
- Covered under Medicare Part B as prosthetic devices
- Includes external breast forms and surgical bras
- Must be prescribed by a Medicare-approved physician
- Typically covered after medically necessary mastectomy
- Replacement prostheses are also covered periodically
- Medicare Part B beneficiaries
- Patients who have undergone mastectomy
- Must have prescription from healthcare provider
- Beneficiaries pay 20% of the Medicare-approved cost after meeting Part B deductible
- Prostheses are typically considered durable medical equipment
- Additional costs may vary depending on specific type of prosthesis
- Must be deemed medically necessary by healthcare provider
- Cosmetic breast prostheses may not be fully covered
- Frequency of replacement is limited
- Requires documentation from treating physician
- Consult with your doctor about medical necessity
- Get a detailed prescription for breast prostheses
- Check with your Medicare plan about specific coverage details
- Keep all medical documentation for Medicare claims
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare breast prosthesesmastectomy prostheticsbreast cancer recoveryMedicare Part Bprosthetic coverage
Related Coverage Topics
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