I 
111TH CONGRESS 
2D SESSION 
H. R. 5447 
To amend title XVIII of the Social Security Act to provide coverage for 
custom fabricated breast prostheses following a mastectomy. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 27, 2010 
Mr. ROSS introduced the following bill; which was referred to the Committee 
on Energy and Commerce, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
coverage for custom fabricated breast prostheses fol-
lowing a mastectomy. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Custom Fabricated Prosthetic Breast Act of 2010’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) There are currently 2,500,000 women in the 
United States living with breast cancer, many of 
whom suffer from unreconstructed breast loss. 
(2) In 2009, an estimated 192,370 women were 
diagnosed with invasive breast cancer that required 
surgery, with many having to undergo surgical 
breast removal. 
(3) Annually, there are more than 130,000 
women 
in 
the 
United 
States 
who 
undergo 
mastectomies, a surgical removal of the breast. 
(4) The number of breast amputations in the 
United States is projected to increase due to the ris-
ing incidence of breast cancer and the growing elder-
ly population. 
(5) A woman suffering from the loss of her 
breast may not be a candidate for surgical breast re-
construction or may choose not to undergo addi-
tional surgery if there were a viable, less costly, less 
invasive option available. 
(6) The results of breast reconstruction surgery 
can vary and, as with any surgical procedure, there 
are inherent risks associated with such surgery. Ad-
ditionally, reconstruction of the breast using im-
plants can impose increased risks and costs due to 
the eventual need for implant replacement surgery. 
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(7) The number of women choosing to undergo 
surgical breast reconstruction continues to increase, 
as many women lack the viable option of custom fab-
ricated prosthetic breasts to restore the lost breast. 
(8) Both older women and minority women are 
less likely to be offered or undergo surgical breast 
reconstruction and are disproportionately disadvan-
taged by a lack of access to the option of custom 
fabricated prosthetic breasts. 
(9) Currently, the Medicare program provides 
coverage and reimbursement for custom fabricated 
prostheses for any body part, with the exception of 
breasts, that has been lost. 
(10) Following passage of the Women’s Health 
and Cancer Rights Act of 1998 (Public Law 105– 
277; 42 U.S.C. 201 note), many private insurers 
and group health plans began to provide coverage 
for custom fabricated breast prostheses as an alter-
native to surgical breast reconstruction. 
(11) While the Medicare program recognizes 
custom fabricated breast prostheses as a discrete de-
vice and valid treatment option, having assigned a 
billing code for such option under the Healthcare 
Common Procedure Coding System (‘‘HCPCS’’) and 
setting a maximum allowable fee, Medicare does not 
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provide reimbursement and downgrades such option 
to a non-custom fabricated ‘‘least costly alternative’’. 
Medicare does provide reimbursement, however, for 
more costly surgical breast reconstruction. 
(12) Due to the fact that the Medicare program 
does not provide reimbursement for custom fab-
ricated breast prostheses, many private insurance 
companies have also begun to limit their reimburse-
ment for them. 
(13) Providing coverage for custom fabricated 
prosthetic breast devices and components will not in-
crease the incidence of breast amputations. 
SEC. 2. COVERAGE. 
(a) IN GENERAL.—Section 1861(s)(8) of the Social 
Security Act (42 U.S.C. 1395x(s)(8)) is amended— 
(1) by striking ‘‘(8) prosthetic devices’’ and in-
serting ‘‘(8)(A) prosthetic devices’’; 
(2) in subparagraph (A), as added by para-
graph (1), by inserting ‘‘and’’ after the semicolon; 
and 
(3) by inserting after subparagraph (A) the fol-
lowing new subparagraph: 
‘‘(B) custom fabricated breast prostheses 
following surgical removal of the breast, includ-
ing replacement of such prostheses;’’. 
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