US · guidance
CMS Pub. 100-03, ch. 1, § 140.2
Breast Reconstruction Following Mastectomy
CIM 35-47
During recent years, there has been a considerable change in the treatment of diseases of the breast such as
fibrocystic disease and cancer. While extirpation of the disease remains of primary importance, the quality
of life following initial treatment is increasingly recognized as of great concern. The increased use of breast
reconstruction procedures is due to several factors:
• A change in epidemiology of breast cancer, including an apparent increase in incidence;
• Improved surgical skills and techniques;
• The continuing development of better prostheses; and
• Increasing awareness by physicians of the importance of postsurgical psychological adjustment.
Reconstruction of the affected and the contralateral unaffected breast following a medically necessary
mastectomy is considered a relatively safe and effective noncosmetic procedure. Accordingly, program
payment may be made for breast reconstruction surgery following removal of a breast for any medical
reason.
Program payment may not be made for breast reconstruction for cosmetic reasons. (Cosmetic surgery is
excluded from coverage under §1862(a)(10) of the Act.)
History
(Rev. 1, 10-03-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
8ac8690ff9d83516d7ba0e91cc5864a7ae52f0422c0ddfd30a460375c90b4a38
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