What You Need to Know Before Using Your Insurance
This page explains how insurance coverage works for post‑mastectomy supplies such as bras, compression items, and breast prostheses. We want you to feel confident and informed when using your insurance benefits. The details below reflect typical rules, but each plan may vary, so always verify with your insurer.
How Insurance Works for Post‑Mastectomy Supplies
Most health plans, including Medicare and major commercial insurers, will cover certain items after a mastectomy when prescribed by a licensed healthcare provider. This typically includes prosthetic devices and mastectomy bras but every plan’s rules are different, especially for replacement items. Check with your insurer to confirm coverage before you order or schedule a fitting.
Insurance companies may require:
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A prescription from your doctor listing the specific item(s) and L‑codes.•
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Prior authorization or additional documentation.
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Use of a supplier that accepts your insurance plan.
Always call your insurance provider before your appointment and ask specifically about “external breast prosthesis (L8020/L8030)” and “mastectomy bras (L8000)” coverage.
Timeline of Care & Covered Items
Pre‑Surgery / Immediately After Surgery
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L8015 – Post‑Op Kit
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Often covered under most insurance plans when prescribed.
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Issued prior to or right after surgery.
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A6528 – Nighttime Compression Garments
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Two garments included when prescribed.
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Covered early in the recovery period.
6–8 Weeks After Surgery
Once you are healing and ready for a permanent fit, plans commonly cover:
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L8000 – Mastectomy Bras
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L8020 – Non‑Silicone Breast Prosthesis
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L8030 – Silicone Breast Prosthesis
These items help restore comfort, symmetry, and normal daily function after surgery.
Typical Insurance Coverage Guidelines
Below are examples of how many items your plan might cover. Always verify what your specific plan will pay:
These limits may vary, and some plans cover additional items or have different timing for replacements.
Important Notes About Coverage
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Prescription Required: Items like bras and prostheses usually require a doctor’s prescription for insurance reimbursement. Medicare and commercial plans often deny claims without one.
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Check with Your Plan: Coverage details, deductibles, coinsurance, and limits change by insurer — call your insurance directly to verify.
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Replacement Rules: Many plans will cover replacements when the item reaches its useful life (e.g., silicone prostheses around 2 years).
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Out‑of‑Pocket Costs: Copays and deductibles may apply depending on your policy.
Non‑Accepted Plans
We do not accept certain insurance plans at this time (for example, Medicaid or Viva). Patients with these plans can still receive products on a cash‑pay basis.
Tips for Using Your Insurance
✔ Call your insurer before ordering or fitting — ask specifically about prostheses and mastectomy bras, and tell them the codes (L8000, L8020, L8030).
✔ Get a copy of your benefits summary — it helps when checking coverage limits.
✔ Use a supplier that works directly with your insurance when possible.