Insurance Information
Health plans and health insurers are required by law to cover the cost of ALL stages of breast reconstruction, including the cost of prosthesis, to restore the breast to its original form and symmetry. Check with your insurance company for the specific information that they require.
In general, you need two items to get reimbursed:
1. An insurance billing form which is available from your insurance company or from your doctor’s office. Click here for a sample insurance billing form.
2. Insurance diagnostic and billing codes for breast cancer/reconstruction. For your benefit, we have provided the diagnostic and billing codes below.
Some insurance companies will also require:
3. A Doctor’s Progress note. It is used as proof of visit to your doctor, and proof that your doctor has recommended ReForma. Click here for a Doctor’s Progress Note that you can print out for your doctor to sign.
Just like in any insurance billing situation, fill out the insurance billing form, fill in the codes provided, and, if your insurance company requires it, attach the Doctor’s Progress Note. In most cases your doctor’s office or insurance company will help you with this insurance filing.
Insurance Billing Codes
ReForma is a covered cosmetic prosthetic device under diagnostic code (ICD-9) 174.0-174.9 which covers “Malignant neoplasm of female breast.”
Medicare recently issued billing code (CPT) L8032 which is for “NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH”
Women’s Health and Cancer Rights Act of 1998
For a summary of your rights, including insurance rights, under the Women’s Health and Cancer Rights Act of 1998, click here.