FAQs for Post Mastectomy

There is a surprising amount of information regarding post-mastectomy care.

  • Not all of it is accurate.
  • Some information is outdated.
  • Some information is country specific.
  • Some information is insurance or payer specific.

The American Association of Breast Care Professionals in partnership with the International Society of Breast Care Professionals have endeavored to gather the most pressing questions regarding mastectomy surgery and post-surgical care.

POST MASTECTOMY FAQs

What is Post Mastectomy Care?

Post Mastectomy services are healthcare items and professional services required after a mastectomy due to breast cancer or trauma, prophylactic mastectomy, or genetically induced developmental conditions of the breast.
Post-mastectomy is always considered healthcare – because these items treat conditions that have resulted from diseases and treatment of diseases of the breast.

What services are included in Post Mastectomy Care?

Always measured face-to-face and by a Certified Fitter.

What items are included in Post Mastectomy Care?

Post Mastectomy Care Treatment consists of the provision of a wide variety of services including measurement and fit of:
post-surgical garments and bras, permanent bras.
external breast prostheses, post-op prostheses, permanent prostheses, and nipple prostheses
custom breast prostheses
pocketed garments (bras, swimsuits, clothing)
lymphedema and post-surgical compression garments

Does Private Insurance cover post-mastectomy items?

Most private insurances plans cover post mastectomy items either in a limited fashion or as a result of WHCRA. However since breast prosthesis are DMEPOS items, they may be subject to a separate deductible.

Does Traditional Medicare cover post-mastectomy items?

Tradition Medicare, FFS, covers post mastectomy items and supplies for a covered mastectomy including breast cancer and prophylactic.

Do Medicare Advantage policies cover post-mastectomy items?

Medicare Advantage policies must follow at the minimum, Traditional Medicare. In this manner, most Medicare Advantage plans cover post mastectomy items and services.

Does state Medicaid cover post-mastectomy items?

Many, but not all state Medicaids cover post mastectomy items. Medicaids limit frequency and number of services.

How many bras are allowed per year?

As many as are medically necessary. This is determined by the patient and her doctors.

What Medicare Documents dictate post mastectomy reimbursement policy?

The External Breast Prosthesis Local Coverage Determination (LCD), The EBP Policy Article, and the Documentation for DME POS Article.