II 

111TH CONGRESS 

2D SESSION S. 3255 

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 

APRIL 22, 2010 

Mrs. LINCOLN (for herself and Ms. SNOWE) 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 ‘‘Custom Fabricated Prosthetic Breast Act of 2010’’. 

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

7 (1) There are currently 2,500,000 women in the 

8 United States living with breast cancer, many of 

9 whom suffer from unreconstructed breast loss. 


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1 (2) In 2009, an estimated 192,370 women were 

2 diagnosed with invasive breast cancer that required 

3 surgery, with many having to undergo surgical 

4 breast removal. 

5 (3) Annually, there are more than 130,000 

6 women in the United States who undergo 

7 mastectomies, a surgical removal of the breast. 

8 (4) The number of breast amputations in the 

9 United States is projected to increase due to the ris10 ing incidence of breast cancer and the growing elder11 ly population. 

12 (5) A woman suffering from the loss of her 

13 breast may not be a candidate for surgical breast re14 construction or may choose not to undergo addi15 tional surgery if there were a viable, less costly, less 

16 invasive option available. 

17 (6) The results of breast reconstruction surgery 

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

19 are inherent risks associated with such surgery. Ad20 ditionally, reconstruction of the breast using im21 plants can impose increased risks and costs due to 

22 the eventual need for implant replacement surgery. 

23 (7) The number of women choosing to undergo 

24 surgical breast reconstruction continues to increase, 


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1 as many women lack the viable option of custom fab2 ricated prosthetic breasts to restore 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 downgrades such option 

25 to a non-custom fabricated ‘‘least costly alternative’’. 


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1 Medicare does provide reimbursement, however, for 

2 more costly surgical breast 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) Providing coverage for custom fabricated 

9 prosthetic breast devices and components will not in10 crease the incidence of breast amputations. 

11 SEC. 2. COVERAGE. 

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

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

14 (1) by striking ‘‘(8) prosthetic devices’’ and in15 serting ‘‘(8) (A) prosthetic devices’’; 

16 (2) in subparagraph (A), as added by para17 graph (1), by inserting ‘‘and’’ after the semicolon; 

18 and 

19 (3) by inserting after subparagraph (A) the fol20 lowing new subparagraph: 

21 ‘‘(B) custom fabricated breast prostheses 

22 following surgical removal of the breast, includ23 ing replacement of such prostheses;’’. 

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

25 of such Act (42 U.S.C. 1395y(a)(7)) is amended by strikVerDate Nov 24 2008 05:01 Apr 23, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3255.IS S3255

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1 ing ‘‘eyewear described in section 1861(s)(8)’’ and insert2 ing ‘‘eyewear described in section 1861(s)(8)(A)’’. 

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

4 this section shall apply to items and services furnished on 

5 or after the date of enactment of this Act. 

Æ 


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