Medicare Reimbursement and Coverage for Post-Mastectomy Products
If you are covered by Medicare, you can receive as many mastectomy bras as are deemed reasonable and necessary as well as one of the following:
- One silicone breast form every 2 years (2 forms for bilateral surgery)
- One Perma-Form Bra every six months
- One foam breast form every 6 months (2 for bilateral surgery)
If Medicare is your primary insurance: In order to qualify for partial Medicare reimbursement, a licensed physician or other licensed healthcare professional, qualified, and eligible to order breast prostheses and other related post-mastectomy products must prescribe the items you are ordering. Jodee will request all necessary documentation, directly from your physician, to assist you in obtaining partial Medicare reimbursement upon your order.
Jodee will file your claim directly to Medicare, if Medicare is your primary insurance. Medicare may partially reimburse you; however Jodee is not currently able to file claims for Medicare Advantage Plans (i.e. HMO, Managed care, Sterling, etc.).
If you have supplemented insurance, you may be entitled to additional reimbursement.
If you are covered by private insurance;
*Most major medical insurance policies cover mastectomy products according to their guidelines.
Jodee encourages you to call your insurance company to verify your benefits. Give them the procedure codes listed below and they will be able to give you information regarding what your policy allows, how much they pay, how many bras and breast forms you are eligible for each year and if you can receive pre-authorization to purchase from Jodee.
Silicone Breast Form - L8030
Foam Breast Form - L8020
Mastectomy Bras - L8000
Perma-Form/unilateral - L8001
Perma-Form/bilateral - L8002
*NOTE : A "Reimbursement Fee Schedule for Bras and Prosthetics" is published by Medicare for the purpose of determining the amount allowable for these items. This amount varies from state to state, and can be lower than our catalog prices. Mastectomy Bras by Jodee will file your claim for you and Medicare will reimburse you for up to 80% of the Medicare fee schedule.