Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2020 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
Following this guidance will help your patients and the Medicare program by verifying there is medical documentation to support the provision of external breast prostheses and supplies.
Medicare coverage requires the patient’s medical record to show a past mastectomy and a valid and complete order. Coverage includes supplies both at the time of the mastectomy and after.
The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) supplier cannot submit a claim for reimbursement until a standard written order (SWO) is provided. The standard written order must contain the elements below. Help your patient by providing this timely.
There must also be information in the patient’s medical record that justifies continued medical need, and it must be made available to the supplier or review contractor upon request.
The following may serve as documentation justifying continued medical need for the External Breast Prostheses and supplies:
For coverage and limitations of these supplies review Local Coverage Determination (LCD) L33317 and Policy Articles A52478 and CMS Local Coverage Article A55426.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 08/27/2020