Breast Prosthesis / Mastectomy Prosthesis

A breast prosthesis, also called a mastectomy prosthesis, is a covered medical device used to restore body contour after breast surgery. Health plans often reimburse part of the cost of external breast forms, specialized bras, or related supplies when deemed medically necessary by a physician.

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Coverage ensures financial support for patients recovering from mastectomy or lumpectomy procedures. Reimbursement limits may apply per breast and per defined time period, such as once every two years.

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Example:

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If your plan covers up to $300 per breast every two years and you purchase prostheses costing $450 each, the plan reimburses $600 in total and you pay $300.

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What to Watch For:

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Pre-authorization or a prescription is often required. Some plans classify post-surgical bras separately with their own smaller maximums.