External Breast Prostheses

Medicare covers external breast prostheses for beneficiaries who have had a mastectomy and covers certain related garments (e.g., L8015 postoperative forms, L8000 mastectomy bras used with approved forms/prostheses) when documentation and coding requirements are met. Coverage is limited to one prosthesis per side for the useful lifetime (two total for bilateral mastectomies); specific HCPCS codes (L8031, L8035) are explicitly denied, and strict documentation (SWO/WOPD, POD, documented refill requests) and refill timing/quantity rules apply.

"An external breast prosthesis is covered for a patient who has had a mastectomy."

Sign up to see full coverage criteria, indications, and limitations.