II 

118TH CONGRESS 

1ST SESSION S. 3069 

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 

OCTOBER 18, 2023 

Ms. DUCKWORTH (for herself and Ms. MURKOWSKI) 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 4,000,000 

8 women with a history of breast cancer in the United 

9 States, many of whom experience unreconstructed 

10 breast loss. 


lotter on DSK11XQN23PROD with BILLS
2 

•S 3069 IS

1 (2) In 2023, an estimated 297,790 women will 

2 be diagnosed with invasive breast cancer that re3 quires surgery, with many having to undergo sur4 gical breast removal. 

5 (3) In 2023, an estimated 43,100 women in the 

6 United States are expected to die from breast can7 cer. 

8 (4) Annually, there are more than 100,000 

9 women in the United States who undergo 

10 mastectomies, a surgical removal of the breast. 

11 (5) The number of breast mastectomies in the 

12 United States has increased among younger women, 

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

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

15 years old. 

16 (6) The results of breast reconstruction surgery 

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

18 are inherent risks associated with such surgery. Ad19 ditionally, reconstruction of the breast using im20 plants requires lifelong follow up to ensure the 

21 health of the patient. 

22 (7) While the number of women choosing to un23 dergo surgical breast reconstruction continues to in24 crease, many women continue to lack the viable opVerDate Sep 11 2014 21:33 Oct 19, 2023 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3069.IS S3069

lotter on DSK11XQN23PROD with BILLS
3 

•S 3069 IS

1 tion of custom fabricated prosthetic breasts to re2 store the lost breast. 

3 (8) Both older women and minority women are 

4 less likely to be offered or undergo surgical breast 

5 reconstruction and are disproportionately disadvan6 taged by a lack of access to the option of custom 

7 fabricated prosthetic breasts. 

8 (9) Currently, the Medicare program provides 

9 coverage and reimbursement for custom fabricated 

10 prostheses for any body part, with the exception of 

11 breasts, that has been lost. 

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

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

14 277; 42 U.S.C. 201 note), many private insurers 

15 and group health plans began to provide coverage 

16 for custom fabricated breast prostheses as an alter17 native to surgical breast reconstruction. 

18 (11) While the Medicare program recognizes 

19 custom fabricated breast prostheses as a discrete de20 vice and valid treatment option, having assigned a 

21 billing code for such option under the Healthcare 

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

23 setting a maximum allowable fee, Medicare does not 

24 provide reimbursement and denies claims as ‘‘not 

25 medically necessary’’. Medicare does provide reimVerDate Sep 11 2014 21:33 Oct 19, 2023 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3069.IS S3069

lotter on DSK11XQN23PROD with BILLS
4 

•S 3069 IS

1 bursement, however, for more costly surgical breast 

2 reconstruction. 

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

4 does not provide reimbursement for custom fab5 ricated breast prostheses, many private insurance 

6 companies have also begun to limit their reimburse7 ment for them. 

8 (13) The Department of Veterans Affairs does 

9 provide the option of a custom fabricated prosthetic 

10 breast for women post-mastectomy. 

11 (14) Providing coverage for custom fabricated 

12 prosthetic breast devices and components will not in13 crease the incidence of breast mastectomies. 

14 SEC. 2. COVERAGE. 

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

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

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

18 end; 

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

20 (3) by inserting after subparagraph (A) the fol21 lowing new subparagraph: 

22 ‘‘(B) custom fabricated breast prostheses fol23 lowing surgical removal of the breast, including re24 placement of such prostheses;’’. 


lotter on DSK11XQN23PROD with BILLS
5 

•S 3069 IS

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 


lotter on DSK11XQN23PROD with BILLS