Medicare & Reconstructive Breast Surgery

[asher]

Help me with my confusion?

Does medicare cover reconstructive breast surgery after cancer or for a women who has a double masectomy because the cancer after 17 years has come back?

Surgeon saying medicare won't cover because it is cosmetic.

I've had patients in years prior have reconstruction and it was covered.

What am I missing?

Thanks for any input from all.

 

[somarco]

Medicare generally doesn’t cover cosmetic surgery unless it’s needed because of
accidental injury or to improve the function of a malformed body part. Medicare
covers breast reconstruction if you had a mastectomy because of breast cancer.
http://www.medicare.gov/Pubs/pdf/10116.pdf

pg 19