II 

116TH CONGRESS 

1ST SESSION S. 562 

To amend title XVIII of the Social Security Act to provide coverage for 

custom fabricated breast prostheses following a mastectomy. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 26, 2019 

Ms. DUCKWORTH (for herself, Ms. MURKOWSKI, Ms. KLOBUCHAR, and Mr. 

BROWN) introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

coverage for custom fabricated breast prostheses following a mastectomy. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Breast Cancer Patient Equity Act’’. 

6 (b) FINDINGS.—Congress finds the following: 

7 (1) There are currently more than 3,500,000 

8 women with a history of breast cancer in the United 


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1 States, many of whom experience unreconstructed 

2 breast loss. 

3 (2) In 2018, more than 260,000 women were 

4 diagnosed with invasive breast cancer that required 

5 surgery, with many having to undergo surgical 

6 breast removal. 

7 (3) In 2018, more than 40,000 women in the 

8 United States are expected to die from breast can9 cer. 

10 (4) Annually, there are 144,000 women in the 

11 United States who undergo mastectomies, a surgical 

12 removal of the breast. 

13 (5) The number of breast mastectomies in the 

14 United States has increased among younger women, 

15 ages 18 to 34 years old, at a rate of 30 percent and 

16 at a rate of 15 percent for women ages 35 to 44 

17 years old. 

18 (6) The results of breast reconstruction surgery 

19 can vary and, as with any surgical procedure, there 

20 are inherent risks associated with such surgery. Ad21 ditionally, reconstruction of the breast using im22 plants requires lifelong follow up to ensure the 

23 health of the patient. 

24 (7) While the number of women choosing to un25 dergo surgical breast reconstruction continues to inVerDate Sep 11 2014 22:57 Mar 01, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S562.IS S562

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1 crease, many women continue to lack the viable op2 tion of custom fabricated prosthetic breasts to re3 store the lost breast. 

4 (8) Both older women and minority women are 

5 less likely to be offered or undergo surgical breast 

6 reconstruction and are disproportionately disadvan7 taged by a lack of access to the option of custom 

8 fabricated prosthetic breasts. 

9 (9) Currently, the Medicare program provides 

10 coverage and reimbursement for custom fabricated 

11 prostheses for any body part, with the exception of 

12 breasts, that has been lost. 

13 (10) Following passage of the Women’s Health 

14 and Cancer Rights Act of 1998 (Public Law 105– 

15 277; 42 U.S.C. 201 note), many private insurers 

16 and group health plans began to provide coverage 

17 for custom fabricated breast prostheses as an alter18 native to surgical breast reconstruction. 

19 (11) While the Medicare program recognizes 

20 custom fabricated breast prostheses as a discrete de21 vice and valid treatment option, having assigned a 

22 billing code for such option under the Healthcare 

23 Common Procedure Coding System (‘‘HCPCS’’) and 

24 setting a maximum allowable fee, Medicare does not 

25 provide reimbursement and denies claims as ‘not 


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1 medically necessary’. Medicare does provide reim2 bursement, however, for more costly surgical breast 

3 reconstruction. 

4 (12) Due to the fact that the Medicare program 

5 does not provide reimbursement for custom fab6 ricated breast prostheses, many private insurance 

7 companies have also begun to limit their reimburse8 ment for them. 

9 (13) The Department of Veterans Affairs does 

10 provide the option of a custom fabricated prosthetic 

11 breast for women post-mastectomy. 

12 (14) Providing coverage for custom fabricated 

13 prosthetic breast devices and components will not in14 crease the incidence of breast mastectomies. 

15 SEC. 2. COVERAGE. 

16 (a) IN GENERAL.—Section 1861(s)(8) of the Social 

17 Security Act (42 U.S.C. 1395x(s)(8)) is amended— 

18 (1) by adding ‘‘and’’ after the semicolon at the 

19 end; 

20 (2) by inserting ‘‘(A)’’ after ‘‘(8)’’; and 

21 (3) by inserting after subparagraph (A) the fol22 lowing new subparagraph: 

23 ‘‘(B) custom fabricated breast prostheses fol24 lowing surgical removal of the breast, including re25 placement of such prostheses;’’. 


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1 (b) CONFORMING AMENDMENT.—Section 1862(a)(7) 

2 of such Act (42 U.S.C. 1395y(a)(7)) is amended by strik3 ing ‘‘1861(s)(8)’’ and inserting ‘‘1861(s)(8)(A)’’. 

4 (c) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to items and services furnished on 

6 or after the date of enactment of this Act. 

Æ 


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