II 

117TH CONGRESS 

1ST SESSION S. 2051 

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 

JUNE 15, 2021 

Ms. DUCKWORTH (for herself, Ms. MURKOWSKI, Mr. BROWN, and Ms. KLOBUCHAR) 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 of 2021’’. 

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

7 (1) There are currently more than 3,800,000 

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 2021, an estimated 281,550 women will 

4 be diagnosed with invasive breast cancer that re5 quires surgery, with many having to undergo sur6 gical breast removal. 

7 (3) In 2021, an estimated 43,600 women in the 

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

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

11 women in the United States who undergo mastecto12 mies, a surgical removal of the breast. 

13 (5) The number of breast mastectomies in the 

14 United States has increased among younger women. 

15 (6) The results of breast reconstruction surgery 

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

17 are inherent risks associated with such surgery. Ad18 ditionally, reconstruction of the breast using im19 plants requires lifelong follow up to ensure the 

20 health of the patient. 

21 (7) While the number of women choosing to un22 dergo surgical breast reconstruction continues to in23 crease, many women continue to lack the viable op24 tion of custom fabricated prosthetic breasts to re25 store the lost breast. 


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1 (8) Both older women and women of color are 

2 less likely to be offered or undergo surgical breast 

3 reconstruction and are disproportionately disadvan4 taged by a lack of access to the option of custom 

5 fabricated prosthetic breasts. 

6 (9) Currently, the Medicare program provides 

7 coverage and reimbursement for custom fabricated 

8 prostheses for any body part, with the exception of 

9 breasts, that has been lost. 

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

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

12 277; 42 U.S.C. 201 note), many private insurers 

13 and group health plans began to provide coverage 

14 for custom fabricated breast prostheses as an alter15 native to surgical breast reconstruction. 

16 (11) While the Medicare program recognizes 

17 custom fabricated breast prostheses as a discrete de18 vice and valid treatment option, having assigned a 

19 billing code for such option under the Healthcare 

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

21 setting a maximum allowable fee, Medicare does not 

22 provide reimbursement and denies claims as ‘not 

23 medically necessary’. Medicare does provide reim24 bursement, however, for more costly surgical breast 

25 reconstruction. 


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

2 does not provide reimbursement for custom fab3 ricated breast prostheses, many private insurance 

4 companies have also begun to limit their reimburse5 ment for them. 

6 (13) The Department of Veterans Affairs does 

7 provide the option of a custom fabricated prosthetic 

8 breast for women post-mastectomy. 

9 (14) Providing coverage for custom fabricated 

10 prosthetic breast devices and components will not in11 crease the incidence of breast mastectomies. 

12 SEC. 2. COVERAGE. 

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

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

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

16 end; 

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

18 (3) by inserting after subparagraph (A) the fol19 lowing new subparagraph: 

20 ‘‘(B) custom fabricated breast prostheses fol21 lowing surgical removal of the breast, including re22 placement of such prostheses;’’. 

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

24 of such Act (42 U.S.C. 1395y(a)(7)) is amended by strik25 ing ‘‘1861(s)(8)’’ and inserting ‘‘1861(s)(8)(A)’’. 


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

2 this section shall apply to items and services furnished on 

3 or after the date of enactment of this Act. 

Æ 


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