Medicare and Mastectomy Products: What's Covered in 2026

A clear breakdown of your Medicare benefits for breast prostheses, bras, and more.

A growing need: Searches for "medicare mastectomy bra coverage" have surged +250% recently. More women on Medicare are looking for clear answers about what's covered. This guide gives you the exact codes, dollar amounts, and steps.

If you're on Medicare and you've had a mastectomy, you have benefits you may not know about. Medicare Part B covers breast prostheses and mastectomy bras -- and the coverage is more generous than most people realize.

What Medicare Part B Covers: The Complete HCPCS Code Reference

Here is every relevant billing code for post-mastectomy products, with the actual national average allowable amounts from the CMS DMEPOS Fee Schedule:

| HCPCS Code | Product | Medicare Allowable (Avg.) | How Often | Requires Rx? | |------------|---------|--------------------------|-----------|-------------| | L8000 | Mastectomy bra (standard) | $52.42 | 6 per calendar year | Yes | | L8001 | Mastectomy bra (custom fitted) | $135.58 | 6 per calendar year | Yes | | L8010 | Mastectomy sleeve (for prosthesis) | $12.98 | 12 per calendar year | Yes | | L8015 | Prosthesis garment with built-in form | $210.76 | 2 per calendar year | Yes | | L8020 | Breast form, non-silicone (fiber-fill "softie") | $117.64 | 1 initial; replacement every 2 years | Yes | | L8030 | Silicone breast prosthesis | $268.31 | 1 per side, every 2 years | Yes | | L8031 | Custom silicone prosthesis | Varies by region | 1 per side, every 2 years | Yes | | L8032 | Nipple prosthesis (prefabricated) | $10.57 | 2 every 6 months | Yes | | L8035 | Custom-molded breast prosthesis | $594.72 | 1 per side, every 2 years | Yes | | L8039 | Breast prosthesis, not otherwise specified | By report | Case-by-case | Yes |

Allowable amounts are national averages from the CMS DMEPOS Fee Schedule and may vary by your Medicare Administrative Contractor (MAC) region.

Your estimated maximum annual benefit can exceed $2,200 when combining bras, prostheses, sleeves, and accessories at maximum frequency. These are benefits you have earned -- please use them.

What You'll Pay

Medicare Part B typically pays 80% of the approved amount after you've met your annual Part B deductible.

Your cost = 20% coinsurance

Here are real-world examples based on the CMS allowable amounts above:

| Product | Medicare Pays (80%) | You Pay (20%) | |---------|-------------------|---------------| | Silicone prosthesis (L8030) | $214.65 | $53.66 | | Standard mastectomy bra (L8000) | $41.94 | $10.48 | | Custom-fitted bra (L8001) | $108.46 | $27.12 | | Custom-molded prosthesis (L8035) | $475.78 | $118.94 |

But if you have a Medigap (supplement) plan, it may cover your 20% -- meaning your total out-of-pocket cost could be $0.

Medicare Advantage Plans

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage may differ. Call your plan's number to verify DME benefits for HCPCS codes L8030 (prosthesis) and L8000 (mastectomy bra).

Requirements

1. Prescription (Detailed Written Order)

You need a written order from your surgeon, oncologist, or primary care doctor (MD, DO, NP, or PA). The prescription must include:

• Your full name
• Diagnosis code: Z90.11 (right breast), Z90.12 (left breast), or Z90.13 (bilateral)
• Items prescribed: External breast prosthesis and/or mastectomy bras
• Statement: "Medically necessary"
• Physician signature, NPI number, and date

Tip: The order must be received before or at the time the product is delivered. Ask your doctor's office to have it ready before your fitting appointment.

2. Medicare-Enrolled DME Supplier

You must purchase from a supplier enrolled in Medicare's DMEPOS program. The supplier must be accredited by a CMS-approved organization and maintain records of your prescription and fitting. (Restored by Randi is pursuing Medicare enrollment. In the meantime, we provide complete superbills for out-of-network reimbursement.)

3. Medicare as Primary Insurance

If you have other coverage, Medicare coordinates with it.

Replacement Schedule

• Breast prosthesis: Replace every 2 years (or sooner if there's a documented change in your body, weight fluctuation, or damage)
• Mastectomy bras: Up to 6 per year - that's a new bra nearly every other month
• Don't wait until things fall apart. If your form is cracking, discolored, or no longer fitting well, it's time for a replacement.

How to Use Your Benefits: Step by Step

1. Get your prescription from your doctor
2. Call us to schedule a fitting
3. Bring your Medicare card and any supplement card
4. We fit you with the right form and bras
5. We submit the claim to Medicare
6. You pay your copay (if any) at time of service
7. Done. We handle everything else.

Frequently Asked Questions

Q: My surgery was 10 years ago. Am I still eligible? A: Yes! There's no time limit. Medicare covers prostheses regardless of when your surgery occurred.

Q: I had bilateral mastectomy. Am I covered for two forms? A: Yes. Medicare covers one prosthesis per side.

Q: I already have a prosthesis. When can I get a new one? A: Every 2 years from the date of your last purchase. If your body has changed significantly, we can request earlier replacement with documentation.

Q: Are lightweight forms covered? A: Yes. Both silicone and lightweight forms are covered under L8030 (or L8020 for partial forms).

Q: Is swimwear covered? A: Medicare coverage for swimwear is limited. Some items may be covered under L8015. We can check your specific situation.

The Access Gap: Why Professional Fitting Matters

Here is something most people don't realize: certified mastectomy fitters are extremely scarce. The NPI (National Provider Identifier) registry for orthotics fitters -- the specialty code that covers mastectomy product fitting -- shows a significant shortage of registered providers across the country. Many states have few or no NPI-registered fitters at all.

This means that for the approximately 107,300 women who undergo mastectomy each year, finding a qualified professional to help with fitting and insurance billing can be a real challenge -- especially in rural areas.

Searches for "certified mastectomy fitter near me" have increased +400% recently. Women are actively looking for help, and there simply aren't enough providers to meet the need.

What this means for you: If you have access to a certified fitter, use that resource. A professional fitting ensures your prosthesis looks natural, your bra fits correctly, and your Medicare claim is coded right the first time. Incorrect coding is one of the top reasons claims get denied.

The Numbers: How Many Women Need These Benefits?

• 313,510 estimated new breast cancer diagnoses per year
• 107,300 estimated mastectomies per year
• 41% of mastectomy patients choose not to have reconstruction
• That means roughly 44,000 women every year rely on external prostheses covered by Medicare and insurance
• 44% of diagnoses occur in women over 65 -- the core Medicare population

The top states by estimated annual mastectomies: California (9,772), Texas (7,360), Florida (5,521), New York (5,204), and Pennsylvania (3,386). No matter where you live, these benefits are available to you.

Don't Leave Benefits on the Table

Every year, thousands of women on Medicare don't use their mastectomy product benefits. With a maximum annual benefit exceeding $2,200, that is real money -- money you've earned through a lifetime of paying into Medicare.

You've paid into Medicare your entire working life. These benefits are yours. Use them.

Schedule Your Medicare Fitting -->

Restored by Randi -- We make Medicare billing easy. West Palm Beach, FL.

Sources: CMS DMEPOS Fee Schedule (2026 national averages), American Cancer Society Cancer Facts & Figures 2025, NPI Registry, Google Trends (March 2026). Allowable amounts may vary by region and MAC.