On June 16, the Breast Cancer Patient Equity Act of 2011 was introduced by Senator Olympia Snowe (R-ME) in the Senate and Representative Mike Ross (D-AR) in the House of Representatives. Known as S. 1217 and H.R. 2233, respectively, the bills serve to amend title XVIII of the Social Security Act to provide coverage for custom-fabricated breast prostheses following a mastectomy.
According to H.R. 2233, the Medicare program provides coverage and reimbursement for custom-fabricated prostheses for any body part that has been lost, with the exception of breasts. The bill goes on to state, “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.” Further, “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.”
The American Association of Breast Care Professionals (AABCP) urges O&P patients and professionals who serve them to contact their congressperson and ask him or her to co-sponsor and support this legislation.
For more information, visit aabcp.org
