External Breast Prosthesis

Aetna covers external breast prostheses and mastectomy bras after a medically necessary mastectomy or lumpectomy and for gender dysphoria — typically up to six mastectomy bras initially (or up to four under some plans), one prosthesis per side for the useful lifetime (exceptions for bilateral mastectomies or gender dysphoria), and bras that hold silicone (or equal) prostheses in a pocket. Key requirements: "initial" mastectomy-related purchases must be made within one year of the mastectomy (not the first after coverage effective date), some plans do not cover replacements so check benefit details, and silicone prostheses with integrated adhesive are considered not medically necessary.

"Covered ICD-10 diagnoses (listed as covered if selection criteria are met): D05."

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