Medicare and Prophalactic Breast Surgery?

Trying to get Medicare to pay for gene testing. My grandmother and mother both had breast cancer, and I'm an Ashkenazi Jew. If I pay for the out of my own pocket, would Medicare cover a bilateral mastectomy and reconstruction?

Doctor Answers 3

Medicare and Prophylactic Breast Surgery?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

In my previous experience with Medicare, they would not preapprove your procedure but would do so after the fact when all the documentation is in.  Although sometimes they do not approve it and you would be responsible for the billing.  In your case it should be covered.

Baton Rouge Plastic Surgeon


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Yes I believe that prophylactic mastectomies and certainly a breast reconstruction is covered by medicare

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Gene Testing and Prophylactic Mastectomies and Reconstruction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

      If you test positive for certain markers, the prophylactic mastectomies as well as the reconstruction with implants may be covered by Medicare.  Kenneth Hughes, MD Los Angeles, CA

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.