U.S. Representative Martha Roby (AL) sent a bipartisan letter with her house colleagues to Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), requesting that CMS modify its coverage to allow breast cancer survivors to have the option to receive custom-fabricated breast prosthetics after a mastectomy.
CMS offers only two choices for women following a mastectomy: surgical breast reconstructive surgery or a prefabricated breast prosthetic. The latter have been described as shapeless, heavier than the normal breast, and hot and cumbersome to wear.
A portion of the letter reads, “Unfortunately, CMS currently deems a custom fabricated breast prosthetic, which is significantly less expensive than reconstructive surgery and would be a custom fit to a woman’s unique body shape and needs, as not reasonable and necessary. Due to this reasoning, women seeking custom fabricated prosthetics have been denied coverage under Medicare and Medicaid… Therefore, we strongly urge you to modify your coverage determination…”
