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DME BILLING

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newlandchr:
I am currently in the process of billing for a DME supplier for Mastectomy bras and prosthesis. The problem I am running into is I can not get a straight answer on whether Medicare will pay for a custom made breast prosthesis (L8035). I used to bill for DME a few years ago and at that time Medicare was not paying for this because it was not medically necessary. But I do not know if this has changed. Does anyone know if this service is covered. I would appreciate anyone help or direction anyone can offer.

Thanks!!

Michele:
I have never billed for these however my aunt had a mastectomy many years ago.  She has since passed away, but I do know that Medicare did pay for her prosthesis.  This Medicare Part B guide also indicates that it is covered:  https://www.medicare.gov/Pubs/pdf/10116.pdf 

newlandchr:
Thank you for your response. I know that they pay for breast forms but what I am asking about specifically is the custom made ones. Last I knew, and this was a few years back, is that they did not cover the custom ones because they were not medically necessary because patients had access to the breast forms, those are already pre-made and not customized to the women's body.

Michele:
Oh, ok.  I am not that familiar with them.  I didn't realize that they weren't custom made.  Must be they have "sizes" and you pick the size closest.  Sorry but I'm not sure.  Do you have a HCPCs code for them?  You could search the LCD/NCD for that HCPCs.

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