Sponsors (30)
The bill increases Medicare patients' awareness and documentation of their right to post-mastectomy reconstruction by tying provider payment to giving notice, improving patient information and compliance but imposing extra administrative work and risking payment denials or care delays if documentation lapses.
Medicare beneficiaries undergoing mastectomy will be explicitly informed that post-mastectomy breast reconstruction is covered, increasing patient awareness of reconstructive options and empowering treatment decisions.
Patients will have a documented record that they received coverage information, improving care planning, supporting appeals, and creating a paper trail for follow-up care.
Tying Medicare payment to compliance creates a clear financial incentive for providers to inform patients and maintain documentation, likely improving overall adherence to the notice requirement.
Providers who fail to give or properly document the notice risk denial of Medicare payment for the mastectomy, potentially causing billing disputes and financial strain for providers.
If payment is withheld for noncompliance, patients could face delays in receiving timely surgical care while providers resolve documentation or payment disputes.
Requiring delivery and documentation of the notice increases administrative burden on providers, adding paperwork and clinic workflow time.
Based on analysis of 2 sections of legislative text.
Requires providers to give and document pre-mastectomy notice that Medicare covers breast reconstruction and conditions Medicare payment on that documentation.
Requires providers who perform mastectomies on Medicare patients to inform the patient, before the mastectomy, that Medicare covers breast reconstruction after a medically necessary mastectomy and to record that notice in the medical record. Medicare payment for the mastectomy is prohibited unless the provider gives the required pre-procedure notice and documents it. Takes effect one year after enactment and applies to mastectomies furnished on or after that date.
Official title: To amend title XVIII of the Social Security Act to require the provision of certain information with respect to breast reconstruction surgery under the Medicare program.
Introduced July 17, 2025 by Maxine Waters · Last progress July 17, 2025