External Breast Prostheses Reimbursement Program

What are the time limits for claiming a reimbursement

You can claim for prostheses you bought after 1 July 2008 even if you had your breast surgery before then.

There must be a 2 year period between the purchase dates of your prostheses if you’re claiming for a replacement.

For example, if you claim for a prosthesis you bought on 1 April 2017, you can’t claim for the cost of a replacement unless it’s bought after 1 April 2019.

Replacement for a medical reason

If it’s been less than 2 years since you bought a prosthesis, you can only claim for a replacement if it’s for a medical reason. The claim must include a letter from your doctor or other health professional explaining the medical reason why you need a new prosthesis.

You can’t claim a reimbursement for a replacement prosthesis, bought less than 2 years after your last purchase, for:

  • wrong choice or change of mind
  • incorrect fitting
  • faulty or damaged prostheses

If you have one of these issues, contact the supplier.

For more information call the Medicare general enquiries line or visit a service centre.

This information was printed Saturday 25 May 2019 from https://www.humanservices.gov.au/individuals/services/medicare/external-breast-prostheses-reimbursement-program/eligibility-payment-rates/what-are-time-limits-claiming-reimbursement It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 24 May 2019