Medicare Coverage of Breast Prostheses (Implants)

What It Is

Breast prostheses (implants) following a mastectomy, including special postsurgical brassiere

What's Covered

Medicare Part B covers the cost of breast prostheses and a postsurgical brassiere following a mastectomy.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for breast prostheses, contact the plan directly.

What Medicare Pays

Medicare Part B pays 80 percent of the Medicare-approved amount.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

5 Comments So Far. Add Your Wisdom.

12 months ago

In order for you to get breast implants, it has to be medically necessary. It's really nice that Medicaid covers those because they can be expensive. You also have to be part of a doctor that allows Medicaid or Medicare.

over 1 year ago

what code do i use for the implants used during breast reconstruction after breast cancer

Anonymous said over 1 year ago

My Comment is that I am a male to female and I would like to know if I could get breast Implants will Medicair pay for the female breast implants,

almost 2 years ago

Can you recommend me guidelines and rules of plastic surgery to make our patients healthy and give them a proper treatment?

about 3 years ago

My Comment is that I am a male to female Transgender and I would like to know if I could get breast Implants in a 38 C Cup on Medicair and have Medicaid pick up the rest of the treatment, my Legal name is John but I like to be called Alicia


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