Martha Roby requests CMS review coverage options for breast cancer survivors

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Alabama 2nd District U.S. Representative Martha Roby wants to allow breast cancer survivors to have the option to receive custom fabricated breast prosthetics after a mastectomy if they so choose.

Roby sent a bipartisan letter with her house colleagues to Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), on Monday requesting that CMS modify its coverage to make the allowance.

As of now, CMS offers only two choices for women following a mastectomy: surgical breast reconstructive surgery or a prefabricated breast prosthetic. The latter have been described as shapeless, heavier than the normal breast, and both hot and cumbersome to wear.

“Since October is designated as Breast Cancer Awareness Month, we are reaching out to you on behalf of the many women who are living with breast cancer, survivors of breast cancer, and those who will be diagnosed in the future,” the letter read. We urge you to review and reconsider the Local Coverage Determination (LCD) L33317 as it relates to L8035 Custom Fabricated Breast Prosthesis.”

The letter continued, “Unfortunately, CMS currently deems a custom fabricated breast prosthetic, which is significantly less expensive than reconstructive surgery and would be a custom fit to a woman’s unique body shape and needs, as not reasonable and necessary. Due to this reasoning, women seeking custom fabricated prosthetics have been denied coverage under Medicare and Medicaid… Therefore, we strongly urge you to modify your coverage determination…”

Read the full letter below:

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