Breast Prostheses

Medicare covers external breast prostheses (including a surgical brassiere) after a mastectomy. Medicare will cover one silicone prosthesis every two years or a mastectomy form every six months. Patients are allowed only one prosthesis per affected side.

There is no coverage for replacement prostheses due to wear and tear before the listed time frame. However, Medicare will cover replacement of these items due to:

Loss
Irreparable damage, or
Change in medical condition (e.g. significant weight gain/loss)

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

Medicare does not cover a mastectomy sleeve, though it is possible it may be covered as part of your hospital stay.