Congresswoman Martha Roby

Representing the 2nd District of Alabama

Roby Advocates for Survivors During Breast Cancer Awareness Month

October 29, 2018
Press Release

WASHINGTON, D.C. – U.S. Representative Martha Roby (R-AL) today sent a bipartisan letter to Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), requesting that CMS modify its coverage determination to allow breast cancer survivors to have the option to receive custom fabricated breast prosthetics after a mastectomy if they so choose.

As of now, CMS offers only two choices for women following a mastectomy: surgical breast reconstructive surgery or a prefabricated breast prosthetic. The latter have been described as shapeless, heavier than the normal breast, and both hot and cumbersome to wear.

Representative Roby’s letter to CMS Administrator Verma states in part:

“Since October is designated as Breast Cancer Awareness Month, we are reaching out to you on behalf of the many women who are living with breast cancer, survivors of breast cancer, and those who will be diagnosed in the future. We urge you to review and reconsider the Local Coverage Determination (LCD) L33317 as it relates to L8035 Custom Fabricated Breast Prosthesis.

“Unfortunately, CMS currently deems a custom fabricated breast prosthetic, which is significantly less expensive than reconstructive surgery and would be a custom fit to a woman’s unique body shape and needs, as not reasonable and necessary. Due to this reasoning, women seeking custom fabricated prosthetics have been denied coverage under Medicare and Medicaid… Therefore, we strongly urge you to modify your coverage determination…”

The full text of Representative Roby’s letter to Administrator Verma can be found here.

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