Medicare Forms and Instructions

Steps to Receive Medicare Reimbursement

To Receive Medicare Medical Reimbursement, complete and mail the following documents to your Medicare Regional Office for your state:

A completed and signed #1490S Medicare reimbursement billing form.
The original receipt showing item purchased and the price.
A copy of the Certificate of Medical Necessity completed and signed by your physician.
A prescription from your physician. You may use our form or a prescription from your physician.
Contact Medicare at 1-800-633-4227 to find the current mailing address for the regional office for your state. Submit the original paperwork to Medicare and always keep a copy of each item for your records.

Medicare Reimbursement

Medicare reimburses 80% of the allowable for one SOFTEE® Camisole immediately post surgery, and one additional Camisole if the SOFTEE® is worn as a permanent prosthesis. Reimbursement dollar amounts vary from state to state. After Medicare pays, secondary insurance carriers are usually required to cover a portion of any remaining cost.

Using Form 1490S for Reimbursement

The SOFTEE® benefit is considered Durable Medical Equipment (DME), and falls under the guidelines of Medicare Part B - or after hospital discharge. However, because the SOFTEE® is a sized garment, it may be dispensed prior to surgery to determine an appropriate fit. The SOFTEE® Camisole benefit is one of several DME items that has received approval for independent patient billing using the 1490S Medicare form for reimbursement.

The Medicare unique HCPCS billing code number for the SOFTEE® is #L8015. The Medicare description for the SOFTEE® is "External breast prosthesis garment, with mastectomy form - post mastectomy".

We do not have a Medicare provider number and are not eligible to file a Medicare claim for you. It is a simple process for a Medicare recipient to file their own claim. If you are not able to file a claim we can refer you to a SOFTEE® retailer who is a Medicare provider, and if you purchase the product from them they will file for you.

Obtaining a 1490s Medicare Form

Download a Sample Form 1490S & Form Instructions.
Go to Medicare Website to download 1490S Billing Form.
Call 1-800-633-4227 to find the Medicare regional office for your State to order the form my mail.
Upon request, a sample of this form will be included with your SOFTEE® shipment.