Bill to Provide Medicare Coverage of Custom Breast Prostheses Reintroduced in Congress

Published in Government Relations on July 25, 2023

U.S. Representatives Judy Chu (D-CA) and Mariannette Miller-Meeks (R-IA) have reintroduced the bipartisan H.R. 4779: Breast Cancer Patient Equity Act, which would provide Medicare coverage of custom breast prostheses to breast cancer survivors. Since most private insurance companies follow Medicare coverage standards, passage of this legislation will allow hundreds of thousands of women each year to choose a custom prosthesis after mastectomy.   

“This is a great step forward in our efforts to expand access to life-changing healthcare for breast cancer survivors,” said Nikki Jensen, vice president of Essentially Women. “We ask that anyone affected by breast cancer, or if you just feel this is the right thing to do, please contact your elected officials and show support for the Breast Cancer Patient Equity Act.” 

Medicare covers most other post-mastectomy treatment options and other custom prosthetic devices; however, custom breast prosthesis is the only prosthetic device not covered by Medicare. Senator Duckworth noted how the new legislation is a step toward achieving health equity for older women and women of color. As breast cancer survival rates increase, so should Medicare coverage of treatment options, Murkowski added.   

“Breast cancer survivors who have undergone a mastectomy deserve to have a full range of affordable reconstructive options,” said Rep. Chu. “There are many reasons why breast cancer patients choose not to have reconstructive surgery, and Medicare should not be limiting reasonable options that allow women to feel comfortable after fighting cancer. I’m grateful to be able to work on this bipartisan bill, and I hope we can pass it quickly so cancer survivors can finally have complete freedom of choice.” 

“During such fragile times when women are dealing with the stress and toll of invasive breast cancer, line items of their insurance coverage are the furthest things from their minds,” said Rep. Miller-Meeks. “The Breast Cancer Patient Equity Act takes away the burden of calculating the coverage for custom prosthetics and gives access to higher quality implants for patients diagnosed with invasive breast cancer that undergo a mastectomy, regardless of their income.” 

For more information and to take action, visit www.peopleforqualitycare.org/letherdecide.  


TAGS

  1. custom breast prosthesis
  2. let her decide
  3. women's health

From Our Experts

Congratulations to CAMPS On This Important Legislative Victory thumbnail Congratulations to CAMPS On This Important Legislative Victory The signing of AB 1794 is another reminder of the critical role state associations play in shaping healthcare policy, removing barriers to patient care, and ensuring providers have a seat at the table when important decisions are made. Legislative successes like this do not happen by accident. They are the result of engaged members, strong advocacy efforts, and collaboration with policymakers to address real-world challenges facing providers and the patients they serve. S.247, Choices for Increased Mobility Act of 2025, Passes U.S. Senate thumbnail S.247, Choices for Increased Mobility Act of 2025, Passes U.S. Senate S.247, Choices for Increased Mobility Act of 2025 has passed in the Senate through unanimous consent. It now heads to the President to be signed into law. Introduced in the Senate by Sen. Tammy Duckworth (D-IL), The Choices for Increased Mobility Act of 2025 would... August Recess Recap: Building Relationships, Advancing Advocacy thumbnail August Recess Recap: Building Relationships, Advancing Advocacy As Congress worked through the August recess, the VGM Government Relations team remained actively engaged in securing meetings and building relationships with legislators, candidates, and key congressional staff across the country. This summer, the team made a strategic decision to focus getting a strong balance between Republican and Democratic offices, recognizing the importance of broadening support for DMEPOS priorities and ensuring policymakers from both parties understand the challenges.. Introducing Patient Voices: Access to HME Matters thumbnail Introducing Patient Voices: Access to HME Matters The VGM Government Relations team is excited to announce Patient Voices: Access to HME Matters, a new way for patients, providers, vendors, caregivers, and industry partners to share their experiences with home medical equipment. Every story matters. AAHomecare Survey Results of RID Program thumbnail AAHomecare Survey Results of RID Program Thank you to AAHomecare for initiating this important survey demonstrating the significant risks to the DMEPOS industry should Remote Item Delivery Competitive Bid Program (RID CBP) Round 2028 move forward as is. VGM Group is proud to support the survey efforts to maximize provider participation. See below for the survey summary and analysis. Competitive Bidding Update: NPEast and NPWest Updating Licensure Requirement Information for Competitive Bidding Product Categories thumbnail Competitive Bidding Update: NPEast and NPWest Updating Licensure Requirement Information for Competitive Bidding Product Categories Per the Remote Item Delivery Competitive Bidding Program (RID CBP) Round 2028 requirements, bidders must meet all business and product category licensure requirements across every state, the District of Columbia, and the U.S. territories to be eligible to be a contract winner. New CMS Nationwide Probationary Prior Authorization Requirement for Newly Enrolled Suppliers of Certain DMEPOS Items thumbnail New CMS Nationwide Probationary Prior Authorization Requirement for Newly Enrolled Suppliers of Certain DMEPOS Items On Sept. 2, 2026, CMS introduced the Probationary Prior Authorization (PPA) program that will place newly enrolled DMEPOS Suppliers and those undergoing 100% change in ownership on a one-year probationary period. Effective Oct. 15, impacted suppliers will be required to submit a prior authorization request for specific HCPCS codes. OIG Report Signals Increased Fraud Oversight for DMEPOS Suppliers thumbnail OIG Report Signals Increased Fraud Oversight for DMEPOS Suppliers The HHS Office of Inspector General (OIG) recently released a white paper examining ongoing Medicare fraud involving durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS).