Breast Reconstructions and Prostheses after Mastectomy RHA News Update – December 16, 2016

Women who have had a mastectomy can receive reconstruction and prosthetic treatment. Eligibility is based on clinical justification and medical necessity documentation by a physician, surgeon, or licensed medical professional. The woman can decide at any time after her mastectomy to have reconstruction; there is no time limit to when she can have this done. She is approved for a one-year post-surgery and will be subject to a yearly redetermination to continue eligibility. A woman who is no longer in treatment, but later experience complications can reapply. Eligibility will be determined by a second-level review completed by the State Office Department of Public Health and its designated staff. If a transgender individual inquires on breast reconstruction and/or prostheses, then refer to Definition-Qualified Transgender for additional information.