Medicare and Prophalactic Breast Surgery?

Question

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?

Kenneth Hughes, MD · Answer

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

Norman Bakshandeh Day, MD, FACS · Answer

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

Thomas Guillot, MD (retired) · Answer

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.

Medicare and Prophalactic Breast Surgery?

Answers (3)