,,ii  #aafth ,,congress  #ast ,session  
,s4 #efb  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #bf1      
#bjai,ms4 ,duckworth 7for herself1 ,ms4 
,murkowski1 ,ms4 ,klobuchar1 and ,mr4   
,brown7 introduced the following bill2  
which was read twice and referred to the
 ,committee on ,finance  ,a ,,bill  ,to 
amend title ,,xviii of the ,social      
,security ,act to provide coverage for  
custom fabricated breast prostheses     
following a mastectomy4  #a4 ,short     
title2 findings  7a7 ,short title ,this 
,act may be cited as the ,breast ,cancer
 ,patient ,equity ,act4  7b7 ,findings  
,congress finds the following3  7#a7    
,there are currently more than          
#c1ejj1jjj women with a history of      
breast cancer in the ,united ,states1   
many of whom experience unreconstructed 
breast loss4  7#b7 ,in #bjah1 more than 
#bfj1jjj women were diagnosed with      
invasive breast cancer that required    
surgery1 with many having to undergo    
surgical breast removal4  7#c7 ,in      

#bjah1 more than #dj1jjj women in the   
,united ,states are expected to die from
 breast cancer4  7#d7 ,annually1 there  
are #add1jjj women in the ,united       
,states who undergo mastectomies1 a     
surgical removal of the breast4  7#e7   
,the number of breast mastectomies in   
the ,united ,states has increased among 
younger women1 ages #ah to #cd years    
old1 at a rate of #cj percent and at a  
rate of #ae percent for women ages #ce  
to #dd years old4  7#f7 ,the results of 
breast reconstruction surgery can vary  
and1 as with any surgical procedure1    
there are inherent risks associated with
 such surgery4 ,additionally1           
reconstruction of the breast using      
implants requires lifelong follow up to 
ensure the health of the patient4  7#g7 
,while the number of women choosing to  
undergo surgical breast reconstruction  
continues to increase1 many women       
continue to lack the viable option of   
custom fabricated prosthetic breasts to 
restore the lost breast4  7#h7 ,both    

older women and minority women are less 
likely to be offered or undergo surgical
 breast reconstruction and are          
disproportionately disadvantaged by a   
lack of access to the option of custom  
fabricated prosthetic breasts4  7#i7    
,currently1 the ,medicare program       
provides coverage and reimbursement for 
custom fabricated prostheses for any    
body part1 with the exception of        
breasts1 that has been lost4  7#aj7     
,following passage of the ,women's      
,health and ,cancer ,rights ,act of     
#aiih 7,public ,law #aje-bgg2 #db       
,u4,s4,c4 #bja note71 many private      
insurers and group health plans began to
 provide coverage for custom fabricated 
breast prostheses as an alternative to  
surgical breast reconstruction4  7#aa7  
,while the ,medicare program recognizes 
custom fabricated breast prostheses as a
 discrete device and valid treatment    
option1 having assigned a billing code  
for such option under the ,healthcare   
,common ,procedure ,coding ,system      

7,,hcpcs7 and setting a maximum         
allowable fee1 ,medicare does not       
provide reimbursement and denies claims 
as #8not medically necessary'4 ,medicare
 does provide reimbursement1 however1   
for more costly surgical breast         
reconstruction4  7#ab7 ,due to the fact 
that the ,medicare program does not     
provide reimbursement for custom        
fabricated breast prostheses1 many      
private insurance companies have also   
begun to limit their reimbursement for  
them4  7#ac7 ,the ,department of        
,veterans ,affairs does provide the     
option of a custom fabricated prosthetic
 breast for women post-mastectomy4      
7#ad7 ,providing coverage for custom    
fabricated prosthetic breast devices and
 components will not increase the       
incidence of breast mastectomies4  #b4  
,coverage  7a7 ,in general ,section     
#ahfa7s77#h7 of the ,social ,security   
,act 7#db ,u4,s4,c4 #aciex7s77#h77 is   
amended--  7#a7 by adding and after the 
semicolon at the end2  7#b7 by inserting

 7,a7 after 7#h72 and  7#c7 by inserting
 after subparagraph 7,a7 the following  
new subparagraph3  7,b7 custom          
fabricated breast prostheses following  
surgical removal of the breast1         
including replacement of such           
prostheses2  4  7b7 ,conforming         
amendment ,section #ahfb7;a77#g7 of such
 ,act 7#db ,u4,s4,c4 #aciey7a77#g77 is  
amended by striking #ahfa7s77#h7 and    
inserting #ahfa7s77#h77;,a74  7c7       
,effective date ,the amendments made by 
this section shall apply to items and   
services furnished on or after the date 
of enactment of this ,act4