Breast Reconstruction Resources - State Laws

Insurance Coverage Required for Post-Mastectomy Breast Reconstruction if Mastectomy is Covered

Alabama

Provides that federally funded and publicly funded state programs that provide coverage for mastectomysurgery shall also provide coverage for reconstruction of the breast. [Section 22-6-10]

http://alisdb.legislature.state.al.us/

Alaska

Conforms state law to federal standards. Provides that health care insurers providing medical andsurgical benefits for mastectomies must comply with 42 U.S.C. 300gg-52 regarding coverage forreconstructive surgery following mastectomies. [Sec. 21.42.400]

http://www.legis.state.ak.us/

Arizona

Conforms state law to federal standards. Provides that health care insurers providing medical andsurgical benefits for mastectomies must comply with 42 U.S.C. 300gg-52 regarding coverage forreconstructive surgery following mastectomies.

Arkansas

Provides that every health benefit plan that provides coverage for mastectomy surgery shall also providecoverage for reconstruction of the breast. [23-99-405]

http://170.94.58.9/

California

Treatment for breast cancer shall include coverage for prosthetic devices or reconstructive surgery torestore and achieve symmetry for the patient incident to a mastectomy. [10123.8.(d)]

http://www.leginfo.ca.gov/

Connecticut

Provides benefits for the reasonable costs of reconstructive surgery on each breast on which amastectomy has been performed, and reconstructive surgery on a nondiseased breast to produce asymmetrical appearance. [Sec. 38a-504(c)]

http://search.cga.state.ct.us/

Delaware

Coverage available for (1) all stages of reconstruction of the breast on which the mastectomy wasperformed; (2) surgery and reconstruction of the other breast to produce a symmetrical appearance;and (3) prostheses and physical complications of mastectomy, including lymphedemas. [§3563]

http://www.delcode.state.de.us/

Florida

Covers prosthetic devices and reconstructive surgery incident to mastectomy, including surgery toreestablish symmetry; surgery must be in a manner chosen by the treating physician. [627.6417]

http://www.flsenate.gov/

Illinois

Coverage for breast reconstruction in connection with a mastectomy shall include (1) reconstruction ofthe breast upon which the mastectomy was performed; (2) surgery and reconstruction of the otherbreast to produce a symmetrical appearance; and (3) prostheses and treatment for physicalcomplications at all stages of mastectomy, including lymphedemas. [ 215 ILCS 5/356g]

http://www.ilga.gov/

Indiana

Covers prosthetic devices and all stages of reconstructive surgery, in the manner determined by theattending physician and patient, including reconstruction of the other breast to produce symmetry. [27-13-7-14]

http://www.in.gov/

Kansas

Covers breast reconstruction, including surgery of the other breast to produce a symmetricalappearance, prostheses and physical complications, in a manner determined in consultation with theattending physician and the patient. [40-2,166]

http://www.kslegislature.org/

Kentucky

Provides coverage for breast reconstruction, including surgery of the other breast to produce asymmetrical appearance, prostheses and physical complications, in a manner determined in consultationwith the attending physician and the patient. [304.18-0983]

http://www.lrc.ky.gov/

Louisiana

Includes coverage for reconstruction of the breast on which the mastectomy has been performed,coverage for surgery and reconstruction of the other breast to produce a symmetrical appearance, andcoverage for prostheses and physical complications, all stages of mastectomy, including lymphedemasand such coverage shall be in a manner determined in consultation with the attending physician and thepatient. [22:250.17]

http://www.legis.state.la.us/

Maine

Provides coverage for reconstruction of the breast on which surgery has been performed and surgeryand reconstruction of the other breast to produce a symmetrical appearance if the patient electsreconstruction and in the manner chosen by the patient and the physician. [§2837-C(2)]

http://janus.state.me.us/legis/

Maryland

Requires coverage for reconstructive surgery resulting from a mastectomy, including surgery performedon a non-diseased breast to establish symmetry. [§15-815]

http://198.187.128.12/

Michigan

Covers breast cancer rehabilitative services, delivered on an inpatient or outpatient basis, includingreconstructive plastic surgery and physical therapy. [500.3616]

Reconstructive surgeryand prosthetic devices are covered after the attending physician has certified medical necessity.[500.3613]

http://www.legislature.mi.gov/

Minnesota

Covers all reconstructive surgery incidental to or following injury, sickness or other diseases of theinvolved part, or congenital defect for a child. Specifically includes benefits for all stages ofreconstruction following mastectomy, including surgery and reconstruction of the other breast toproduce a symmetrical appearance and prostheses. Also specifies that limitations on reconstructivesurgery do not apply to reconstructive breast surgery following medically necessary mastectomy.[ 62A.25].

http://www.revisor.leg.state.mn.us/

Missouri

Covers prosthetic devices and reconstructive surgery necessary to achieve symmetry, as recommendedby the oncologist or primary care physician. [376.1209]

http://www.moga.state.mo.us/

Montana

Covers reconstructive surgery following a mastectomy resulting from breast cancer, including all stagesof reconstructive surgery on the non-diseased breast to establish symmetry and costs of any prostheses.[ 33-22-135].

http://data.opi.mt.gov/

Nebraska

Requires coverage for medical and surgical benefits for mastectomy and for all stages of reconstructionof the breast after a mastectomy has been performed and reconstruction of the other breast to producea symmetrical appearance. The measure also requires coverage for prostheses and physicalcomplications of mastectomy. [44-797].

http://srvwww.unicam.state.ne.us/

Nevada

Covers at least two prosthetic devices and reconstructive surgery incident to mastectomy, includingsurgery to reestablish symmetry. [NRS 608.157]

http://www.leg.state.nv.us/

New Hampshire

Covers breast reconstruction, including surgery and reconstruction of the other breast to produce asymmetrical appearance, in the manner chosen by the patient and physician. [417-D:2-b].

http://www.gencourt.state.nh.us/

New Jersey

Covers reconstructive breast surgery, including coverage to achieve and restore symmetry, and providesbenefits for prostheses. [ 17B:26-2.1a.]

http://lis.njleg.state.nj.us/

New York

Covers breast reconstruction following mastectomy, including reconstruction on a healthy breastrequired to achieve reasonable symmetry, in the manner determined by the attending physician and thepatient to be appropriate. [§3221].

North Carolina

Provides coverage for reconstructive breast surgery, including all stages and revisions of surgeryperformed on a non-diseased breast to establish symmetry, and reconstruction of the nipple/areolarcomplex without regard to the lapse of time between mastectomy and reconstruction, as well ascoverage for prostheses and physical complications in all stages of mastectomy, including lymphademas.[ §58-51-62]

http://www.ncleg.net/

North Dakota

Specifies that health insurance policies may not be issued or renewed in the state unless they providethe benefit provisions of the 1998 Federal Womens' Health and Cancer Rights Act. [26.1-36-09.11]

http://www.legis.nd.gov/

Oklahoma

Covers reconstructive breast surgery performed as a result of a partial or total mastectomy, including allstages of reconstructive surgery performed within 2 years on a non-diseased breast to establishsymmetry. [§36-6060.5.(D)]

http://www2.lsb.state.ok.us/

Pennsylvania

Covers prosthetic devices and breast reconstruction, including surgery on the opposite breast to achievesymmetry, within six years of the mastectomy date. Additional legislation adds language consistent withfederal law.

Rhode Island

Covers prosthetic devices and reconstructive surgery to restore and achieve symmetry incident to amastectomy. Surgery must be performed within 18 months of the original mastectomy. [§27-18-39]

http://www.rilin.state.ri.us/

South Carolina

Covers prosthetic devices and breast reconstruction, including the non-diseased breast, if determinedmedically necessary by the patient and attending physician with the approval of the insurer. [38-71-130]

http://www.scstatehouse.net/code/t38c071.htm

Tennessee

Covers all stages of reconstruction for the diseased breast, excluding lumpectomy, and procedures torestore and achieve symmetry between the breasts, in the manner chosen by the patient and physician,within 5 years of the reconstructive surgery on the diseased breast. [56-7-2507]

http://198.187.128.12/

Texas

Covers reconstruction of the breast incident to mastectomy, including procedures to restore and achievesymmetry, for contracts delivered, issued for delivery or renewed on or after Jan. 1, 1998. 1999 amendment conforms statute to federal law. [§1357.004]

http://www.capitol.state.tx.us/

Utah

Follows the example of the federal statute by requiring coverage for medical and surgical benefits formastectomy and for all stages of reconstruction of the breast after a mastectomy has been performedand reconstruction of the other breast to produce a symmetrical appearance. The measure also requirescoverage for prostheses and physical complications of mastectomy. [31A-22-630]

http://www.livepublish.le.state.ut.us/

Virginia

Covers reconstructive breast surgery performed coincident with a mastectomy performed for breastcancer or following the mastectomy, and surgery performed to reestablish symmetry between the twobreasts. [§ 38.2-3418.4]

http://leg1.state.va.us/

Washington

Covers reconstructive breast surgery if mastectomy resulted from disease, illness or injury, includessurgery to reestablish symmetry. [ 48.46.280]

http://search.leg.wa.gov/

West Virginia

Includes coverage for reconstruction of the breast on which mastectomy was performed and theopposite breast for symmetry; also provides coverage for prosthesis and complications as determined inconsultation with attending physician and patient. [§33-16-3]

http://www.legis.state.wv.us/

Wisconsin

Covers breast reconstruction of the affected tissue incident to mastectomy and specifies that suchsurgery is not considered cosmetic. [149.14(4)(a)]

http://folio.legis.state.wi.us/