Medicare Breast Reconstruction Access and Information Act
Sponsored By: Representative Waters
Introduced
Summary
Pre-surgery patient notice and documentation about breast reconstruction coverage. This bill would require the supplier who performs a mastectomy to tell the patient, before the surgery, that Medicare covers breast reconstruction after a medically necessary mastectomy under National Coverage Determination 140.2 and to record that discussion in the patient's medical record. Affected mastectomies furnished on or after one year after enactment would not be paid by Medicare unless those two steps are completed beforehand.
Show full summary
- Patients: People getting a mastectomy would receive explicit, preoperative notice that breast reconstruction is covered and that this discussion will be entered in their medical record. This aims to make coverage information clearer at the point of care.
- Providers and suppliers: Hospitals, surgeons, and other suppliers would need to add a pre-surgery step to inform patients and document it in charts. Failure to document could lead to denied Medicare payment for that mastectomy.
- Medicare program: Payment for covered mastectomies would be conditioned on supplier compliance with the notice and documentation rule, tied to National Coverage Determination 140.2.
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Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Reconstruction coverage notice before Medicare mastectomy
If enacted, Medicare would only pay for a mastectomy starting 1 year after enactment if your provider tells you before surgery that breast reconstruction after a medically necessary mastectomy is covered by Medicare (national coverage determination 140.2). The provider would also have to note this in your medical record. If the notice and record are missing, Medicare would not pay for the mastectomy. This adds counseling and paperwork but does not change who can get Medicare.
Sponsors & CoSponsors
Sponsor
Waters
CA • D
Cosponsors
Garcia (TX)
TX • D
Sponsored 7/17/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 7/17/2025
Velazquez
NY • D
Sponsored 7/17/2025
Wasserman Schultz
FL • D
Sponsored 7/17/2025
Dingell
MI • D
Sponsored 7/17/2025
Clarke (NY)
NY • D
Sponsored 7/17/2025
Fields
LA • D
Sponsored 7/17/2025
Johnson (GA)
GA • D
Sponsored 7/17/2025
Tlaib
MI • D
Sponsored 7/17/2025
Thompson (MS)
MS • D
Sponsored 7/17/2025
Sewell
AL • D
Sponsored 7/17/2025
Gottheimer
NJ • D
Sponsored 7/17/2025
Watson Coleman
NJ • D
Sponsored 7/17/2025
Thanedar
MI • D
Sponsored 7/17/2025
Lee (PA)
PA • D
Sponsored 7/17/2025
Latimer
NY • D
Sponsored 7/17/2025
Wilson (FL)
FL • D
Sponsored 7/17/2025
Veasey
TX • D
Sponsored 7/17/2025
Cohen
TN • D
Sponsored 7/17/2025
Lynch
MA • D
Sponsored 7/17/2025
McIver
NJ • D
Sponsored 7/17/2025
Garcia (IL)
IL • D
Sponsored 7/17/2025
Cherfilus-McCormick
FL • D
Sponsored 7/17/2025
Salinas
OR • D
Sponsored 7/17/2025
Olszewski
MD • D
Sponsored 7/17/2025
Rescom. Hernández, Pablo Jose [D-PR-At Large]
PR • D
Sponsored 7/22/2025
Trahan
MA • D
Sponsored 9/9/2025
McDonald Rivet
MI • D
Sponsored 9/9/2025
Johnson (TX)
TX • D
Sponsored 9/9/2025
Roll Call Votes
No roll call votes available for this bill.
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