Insurance Benefits

Breast Cancer products, like mastectomy bras and breast forms, are covered by Medicare and insurance providers. Understanding these benefits can be daunting, especially while trying to navigate and understand coverage after being newly diagnosed. On this website, every Product Facts page has specific insurance information...for you and your medical team.

 See key below found on all Product Facts pages.

Patient Information
Medical Team Information

Should you need to speak to someone about understanding your benefits, please contact PRP to schedule a consultation.

 

You should have a wardrobe of bras and breast forms! One style bra limits what you can wear and you most likely have something in your closet right now that may need a different bra or breast form than you are currently using. You might need a convertible bra or a J-hook Bra for that 'cold shoulder' look.
Your insurance provider typically covers only one silicone breast form every 2 years. However, you may want to have a Contact breast form for that special occasion or want a second silicone breast form to use while traveling or daily wear. You definitely need a lightweight breast form for leisure wear and when you want to participate in anything from Yoga to going to the Beach.  Active Lifestyle Breast Form

Keeping up with insurance benefits can be stressful. You should be aware of the benefits your insurance provider offers. Medicare and other Payers (BCBS, Cigna, United Health Care, etc.) all cover many L-Coded products but have certain limits. All breast cancer products for you have a billing code. Medicare uses the following 'L' codes to identify products. Other Payers often refer to these Medicare codes in order to determine your benefits. You should have these L codes on hand if you are calling to check your benefits. ALWAYS document calls to your insurance company with a reference ID number and date of the call. Keep this in a notebook or binder with your other medical information.

L8000      Mastectomy Bra
L8015      External Prosthesis Garment
L8020      Breast Prosthesis Non-silicone
L8030      Breast Prosthesis Silicone
L8032      Reusable Nipple Prosthesis
L8035      Custom Breast Prosthesis 

Medicare Beneficiaries: You can request reimbursement for any L Coded products using the 1490S DME claim form. The link below will take to the Medicare site. Pay special attention to the mailing address for submission. The address is specific to the state you live in.

BCBS, CIGNA, AETNA, United Health, etc. Payers: You can probably file for reimbursement for any L Coded products purchased on line using your insurance carrier's specific reimbursement insurance form. Below is a sample form from BCBS. I was told this is a 'universal form' SO your insurance company should have the equivalent. Don't forget every payer is different in every state and as you know benefits can change from year to year. You may still have to meet various deductibles, stay in network and need to ask specifically about L coded Durable Medical Equipment (DME) products.Medicare uses these L Codes as billing codes and other payers often refer to these codes to determine their own DME breast care benefits for you. 

BCBS Sample Form