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General Information

At Relieve Medical Supply, we help women live fuller life after breast surgery. We offer a full range of breast forms, Bras, Camisoles, Accessories, etc.

Our staff is educated and trained in fitting women who have undergone a mastectomy, lumpectomy, or other reconstructive surgery with Breast Prosthesis, which includes mastectomy Bras and Mastectomy Forms. Women will receive private assistance during their fitting in the comfort of our private Mastectomy room. We will help you find the right Forms, and or Bras that you will be comfortable with.

Please contact us to schedule your fitting appointment, or to see if we may be of assistance in any other way.

Brands / Manufacturers

Form / Bra / Camisole

We are able to special order any brand or style that we don't have in our stock. Just tell us what style or brand you want, we will get it for you.

Educational Info:

Coverage Criteria

 A Breast Prosthesis is covered by most insurances for a patient who has had a mastectomy, and if the following criteria are met: 

  1. A detailed written signed and dated order must be received by the supplier before a claim is submitted, else it will be denied as not medically necessary.
  2. Have ICD-9-CM diagnosis codes V45.71, 174.0-174.9, or 233.0.
  3. Be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member
  4. Meet all other applicable Insurance / Medicare statutory and regulatory requirements.

An external Breast Prosthesis garment, with mastectomy form (L8015) is covered for use in the postoperative period prior to a permanent Breast Prosthesis or as an alternative to a Mastectomy Bra and Breast Prosthesis.

  1. A mastectomy Bra (L8000) is covered for a patient who has a covered mastectomy form (L8020) or silicone (or equal) Breast Prosthesis (L8030, L8031, L8035) when the pocket of the Bra is used to hold the form/Prosthesis.
  2. One SILICONE BREAST FORM every 2 years ( 2 forms for bilateral surgery )         - OR- 
  3. One FOAM BREAST FORM every six months ( 2 forms for bilateral surgery)           - OR-   
  4. One PERMAFORM BRA every six months ( 2 for bilateral surgery)                             

Replacement:

An External Breast Prosthesis of the same type can be replaced at any time,

1)     If it is lost or is irreparably damaged (this does not include ordinary wear and tear).

2)     An external Breast Prosthesis of a different type can be covered at any time if there is a change in the patient's medical condition necessitating a different type of item. The Medicare program will pay for only one Breast Prosthesis per side for the useful lifetime of the Prosthesis.

Quantity:

  1. Only 3-month quantity of supplies and accessories can be dispensed at a time.
  2. The beneficiary or caregiver must specifically request new items before they are dispensed.
  3. Subsequent refills / delivery will take place no sooner than approximately 5 days prior to the end of usage for the current product.

 Documentation Requirements 

  1. Detailed Written Order from your treating physician
  2. Detailed medical records documenting your condition and treatment plan. (These records may include your history and physical exam notes, and clinical face-to-face exam notes)
  3. Documentation of proof of delivery


HCPC Codes:

Code

Description

A4280

ADHESIVE SKIN SUPPORT ATTACHMENT FOR USE WITH EXTERNAL BREAST PROSTHESIS, EACH

L8000

BREAST PROSTHESIS, MASTECTOMY BRA

L8001

BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM, UNILATERAL

L8002

BREAST PROSTHESIS, MASTECTOMY BRA, WITH INTEGRATED BREAST PROSTHESIS FORM, BILATERAL

L8010

BREAST PROSTHESIS, MASTECTOMY SLEEVE

L8015

EXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM, POST MASTECTOMY

L8020

BREAST PROSTHESIS, MASTECTOMY FORM

L8030

BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE

L8031

BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE

L8032

NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH

L8035

CUSTOM BREAST PROSTHESIS, POST MASTECTOMY, MOLDED TO PATIENT MODEL

L8039

BREAST PROSTHESIS, NOT OTHERWISE SPECIFIED
















ICD-9 Codes that Support Medical Necessity

The presence of an ICD-9 code listed in this section is not sufficient by itself to assure coverage. Refer to the section on “Indications and Limitations of Coverage and/or Medical Necessity” for other coverage criteria and payment information.

Code

Description

174.0

MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST

174.1

MALIGNANT NEOPLASM OF CENTRAL PORTION OF FEMALE BREAST

174.2

MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF FEMALE BREAST

174.3

MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF FEMALE BREAST

174.4

MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF FEMALE BREAST

174.5

MALIGNANT NEOPLASM OF LOWER-OUTER QUADRANT OF FEMALE BREAST

174.6

MALIGNANT NEOPLASM OF AXILLARY TAIL OF FEMALE BREAST

174.8

MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE BREAST

174.9

MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE

198.81

 SECONDARY MALIGNANT NEOPLASM OF BREAST

233.0

CARCINOMA IN SITU OF BREAST

457.0

 POSTMASTECTOMY LYMPHEDEMA SYNDROME

V10.3

 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST

V45.71

ACQUIRED ABSENCE OF BREAST AND NIPPLE

 

 

 

 

 

 

 

 

 

 

 






Medicare Links

Medicare / LCD

Articles

FAQs

Q: How many bras will my insurance cover?

A: Medicare and most insurance providers usually cover between 2 to 6 bras every year. Check with your insurance provider before visiting your fitter.

Q: Will my insurance cover my breast prosthesis?

A: Medicare and most private insurance providers usually cover one silicone breast form every two years. If you had a bilateral mastectomy, then you are normally entitled to two silicone breast forms every two years. For non-silicone prostheses, Medicare and most insurance providers normally allow one form every 6 months. Non-silicone breast forms are commonly used immediately after surgery and for leisure wear. Wait at least 6 weeks after surgery or based on your doctor's recommendation before you transition into a silicone breast form. 

Q: Is there anything I need to bring to my first fitting appointment?

A: Make sure that you have a prescription from your doctor. This will help the fitter know exactly what you need and what needs to be covered by your insurance.  Both a breast prosthesis and post-mastectomy bra require a prescription.  

Q: What happens if I lose (gain) weight and need to change my breast prosthesis and/or bra?

A: If you experience weight loss or gain and require a new prosthesis and/or bra, you must have a prescription from your doctor. There must be a weight gain or loss of 20 lbs. in order for your doctor to write another prescription. This prescription is required for insurance reimbursement.

Q: What is a breast form?

A: A breast form is an external prosthesis that can be worn inside the pocket of a bra. Breast forms are designed to resemble natural breast tissue and are therefore made of silicone.

Q: Why do I need to wear a breast form?

A: Wearing a breast form will help you to restore the weight that's missing from your chest wall. Even though wearing a breast form can enhance your overall appearance, not wearing one can cause physical alterations as well.  A weighted breast form will restore your body's natural balance. It will prevent spinal curvature, shoulder drop, and lower back and neck pain.

Q: How do I clean my breast form?

A: Clean your breast form daily in lukewarm water with mild soap. Dry off with a soft towel. Once clean, store your breast form, nipple side down in the travel case provided.

Q: What happens if I puncture my breast form?

A: Your breast form is not covered under warranty if punctured. Since Medicare and most private insurance providers will only cover one breast prosthesis (two if you're bilateral) every 2 years, then it's extremely important that you take all necessary precautions to preserve your breast form. This means storing your breast form in the travel case when not in use and staying away from sharp objects.  

Q: Can I swim in my breast form?

A: It is recommended that you opt for a swim form which was designed specifically for swimming. ABC offers 2 swim forms from which you can choose.

Q: How long will my breast form last?

A: Breast forms have a life expectancy of 2 years. Medicare and most private insurances grant you an allowable for a new prosthesis every 2 years. If you have a bilateral, you're allowed 2 breast forms every 2 years.

Q: Is there a breast form that keeps me cool?

A: If you're looking for a cooler breast form, the patented Massage Form® was proven to reduce perspiration when compared to a standard back breast form. The special channels on the back layer allow air to circulate between you and the form.

Q: Can I get a lighter breast form?

A: Our Lightweight breast forms and Ultra Light breast forms are lighter when compared to standard silicone. Ultra Light is an exclusive creation from ABC. Having a weighted breast form is important, but we know that too much weight can become cumbersome. Depending on your preference, ABC provides 3 different types of silicone: standard, lightweight and ultra light. Lightweight and ultra light are respectively 30% and 45% lighter than standard silicone.

Q: I need to restore symmetry after a lumpectomy, reconstruction or breast conserving surgery. What will work best for me?

A: Shapers, also known as partials, are designed to restore symmetry, helping you achieve a balanced look and feel. ABC provides a variety of shapers depending upon your need.

Q: Will people be able to tell the difference between my natural breast and my breast form?

A: No, breast form technology has made great strides. With a proper fitting, you will find the right breast form and bra to make you look balanced and feel confident. As an added measure, it's helpful to know that our silicone breast forms are completely "huggable". So don't worry about the feel of your breast forms. No one will be able to tell. Your breast form will pass the "hug test" with flying colors!

Q: Why should I be seen by a certified fitter?

A: Every woman is different – so is every bra and every best form. It's best to have a certified fitter help you look at what works best for your size, frame and build.

Q: What should I do if my breast size changes before I'm due for a replacement?

A: Before you go for another fitting, you should check with your doctor. You need to have another prescription in order for your insurance cover another breast form(s).

Q: Can I wear a breast form without wearing a pocketed post-mastectomy bra?

A: Yes, you can, but you may find it easier to wear a pocketed bra that was designed to hold the weight of a breast form. Other bras may not be able to sustain the weight of the breast form. A post-mastectomy bra gives you the added security that you need.

Q: When should I start wearing a breast form?

A: Immediately following your surgery, you should be seen by a fitter. It is recommended that you get fitted with a non-silicone form. This should be worn for at least 6 weeks after your surgery.  When your doctor determines that you're ready for a weighted prosthesis, then he/she will write you a prescription for a silicone breast form.  A silicone breast form has a guaranteed life of 2 years.

Q: Is silicone safe to use?

A: Silicone is deemed a safe material to use in the production of an external breast prosthesis. 

Q: What's the difference between a post-mastectomy bra and regular bra?

A: Post-mastectomy bras are designed with a pocket on the inside of the bra cup. This pocket is designed to hold your breast prosthesis in place. Additionally, there are design features that allow for the added weight of a silicone breast form. There are a variety of bras because there are a variety of women. A certified fitter will consult with you to determine which bra works best for you.

Q: How many bras will my insurance cover?

A: Medicare and most insurance providers will usually cover several bras up to a 3 month supply each time. To be certain, ask your doctor to specify the number of bras on your prescription. Also check with your insurance provider before visiting your fitter.

Q:How will I know which bra will work the best for me?

A: Every woman is designed differently. It's best to be fitted by a certified mastectomy fitter before you purchase your post-mastectomy bra. The fitter will consult with you to determine if a seamless molded cup works better than a soft cup bra. Regardless of how much you think you know about bras, it's always best to see how it fits on you. When choosing a bra you want to consider three things: comfort, confidence, and ease of wear.

Q: Now that I have to wear a breast form, will I have to wear an unattractive and unflattering bra?

A: In your search to find the right bra, you will discover that many post-mastectomy bras by ABC are designed to reflect the current fashion trends in the market. There are a number of bras that provide the beauty you want as well as the support you need. 

Q: How many bras will my insurance cover?

A: Medicare and most insurance providers usually cover between 2 to 6 bras every year. Check with your insurance provider before visiting 
your fitter.

Q: Will my insurance cover my breast prosthesis?

A: Medicare and most private insurance providers usually cover one silicone breast form every two years. If you had a bilateral mastectomy, then you are normally entitled to two silicone breast forms every two years. For non-silicone prostheses, Medicare and most insurance providers normally allow one form every 6 months. Non-silicone breast forms are commonly used immediately after surgery and for leisure wear. Wait at least 6 weeks after surgery or based on your doctor's recommendation before you transition into a silicone breast form.

Q: Is there anything I need to bring to my first fitting appointment?

A: Make sure that you have a prescription from your doctor. This will help the fitter know exactly what you need and what needs to be covered by your insurance. Both a breast prosthesis and post-mastectomy bra require a prescription.

Q: What happens if I lose (gain) weight and need to change my breast prosthesis and/or bra?

A: If you experience weight loss or gain and require a new prosthesis and/or bra, you must have a prescription from your doctor. There must be a weight gain or loss of 20 lbs. in order for your doctor to write another prescription. This prescription is required for insurance reimbursement. 

Contact

Information

11490 Hanson Blvd. N.W.
Coon Rapids, MN 55433
Map & Directions »

Contact No. 763-780-3002
Fax No. 763-780-3008
Email info@relievemedical.com
Business Hours:
Mon - Fri    9am - 5:30pm
Sat & Sun    Closed
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