Medicare Breast Reconstruction Access and Information Act

This bill makes sure Medicare patients are told, before a mastectomy, that Medicare covers breast reconstruction after a medically necessary mastectomy. Doctors or other providers must give this information and note it in the patient’s medical record. If they don’t, Medicare won’t pay for the mastectomy. This rule ties to Medicare’s existing national coverage policy for breast reconstruction (NCD 140.2) and is meant to ensure patients know their options ahead of surgery.

The requirement starts one year after the law is enacted, giving time for hospitals and clinics to put the process in place.

• Who is affected: Medicare patients having a medically necessary mastectomy, and the providers who perform it.
• What changes: Providers must tell patients that Medicare covers post-mastectomy breast reconstruction and document that they did so; otherwise Medicare won’t pay for the mastectomy.
• When: Takes effect 1 year after enactment.