Medicare Forms & Instructions

ALERT: It has been brought to our attention that Medicare has denied some claims for reimbursement for the SOFTEE® when billed on the 1490S Claim Form (Patients Request for Medical Payment), stating the reason for denial is that,LLC, does not have a Medicare Provider Number. provides Instructions for Medicare self-billing so that patients can be reimbursed the Medicare allowable amount for their purchase of the SOFTEE®. We have been doing so for over eight years with no problems that we have been made aware of. Our President has contacted Medicare and verified with them that at this time a Medicare Provider Number is not required for the SOFTEE® when billed by the patient on the 1490S. We have contacted both Medicare and our Oregon State Senators office to find out why some claims are being denied. In the meantime we understand if you should choose to purchase the SOFTEE® from a local retail store who has a Medicare Provider number and will file the medical claim for you.

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

More Questions?

If you have questions, need us to send you the 1490S Medicare Reimbursement Form, or if you would like a referral to a local provider, contact our customer care department by calling toll free 1-866-605-8585, and we will be happy to assist you. Our business hours are Monday through Friday from 8:00am to 5:00pm Pacific Time.