Iowa Medicaid Coverage of Custom Breast Prosthesis
on April 03, 2023
On Thursday, March 30, Nikki Jensen and Tom Powers met with Iowa State Representative Timi Brown-Powers and officials from Iowa Health and Human Services (HHS) to discuss Iowa Medicaid’s coverage of custom breast prosthesis for patients.
It was discovered that suppliers submitting custom breast prosthesis claims for Medicaid patients in Iowa have been facing denials from at least one MCO due to Iowa Medicaid following Medicare guidelines. However, during the meeting, HHS representatives confirmed that custom breast prosthesis (L8035) is now covered under Iowa Medicaid with a reimbursement rate of $2,769.53.
This is great news for Medicaid patients in Iowa, as they can now receive the custom breast prosthesis they need to feel comfortable and confident in their everyday lives. In the event that a supplier has received a Medicaid denial for L8035, HHS representatives encourage them to contact Essentially Women to review the issue with the MCO. Those with information on the date of service of the Medicaid denial can contact Nikki Jensen at Nicole.Jensen@vgm.com.
This meeting highlighted the importance of advocating for access to custom breast prosthesis, for Medicaid patients, particularly in states where coverage is currently unavailable. If you reside in a state that does not allow coverage for custom breast prosthesis for Medicaid patients, please contact Nikki Jensen to discuss a strategy to gain access.
We are grateful for the hard work and dedication of those involved in advocating for this important issue and hope that other states will follow in Iowa’s footsteps in covering custom breast prosthesis for Medicaid patients.