#SFHS2613155AFrance updates reimbursement renewal rules for external breast prostheses
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
The order shortens the standard reimbursement renewal period for external silicone breast prostheses from 18 months to 12 months in the relevant product listings. It confirms that an initial silicone prosthesis can be covered after the healing period, at least two months after surgery, and that the first renewal can occur after 12 months because medical and physical changes may happen during the first year after mastectomy. Patients, prescribing doctors, suppliers and listed manufacturers are affected. Later renewals generally require a new prescription after at least 12 months, while early renewals need to follow social security rules and, from the first renewal onward, require prior approval requested by the prescribing doctor.
AI-generated summary. May contain errors. Refer to official sources for legal decisions.
Key Changes
- Shortens the minimum reimbursement renewal period for external silicone breast prostheses from 18 months to 12 months in listed product entries.
- Confirms that initial reimbursement can begin after the healing period, at least two months after surgery.
- Requires a new prescription for regular renewals and prior approval for early renewals after the first renewal.
Obligations
What this law requires
An external silicone breast prosthesis may be reimbursed only after the end of the healing period and at least 2 months after the operation.
The first renewal of reimbursement coverage for an external silicone breast prosthesis may occur only from the end of the 12th month of coverage.
Subsequent renewals of reimbursement coverage for external silicone breast prostheses require a minimum 12-month interval and presentation of a new prescription.
Any early renewal of reimbursement coverage for an external silicone breast prosthesis must comply with Article R. 165-24 of the Social Security Code.
From the first renewal onward, any early renewal reimbursement coverage is granted only after prior approval requested and completed by the prescribing doctor.