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The bill increases Medicare patients' awareness and documentation of coverage for post-mastectomy reconstruction and strengthens provider incentives to comply, but does so by imposing administrative requirements 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 supporting informed decisions.
Patients will have a documented record confirming they received coverage information, which helps with later care planning, appeals, and continuity of care.
Linking Medicare payment to compliance creates a stronger incentive for providers to inform patients and keep records, encouraging consistent implementation of the notice requirement.
Providers who fail to give or properly document the notice risk denial of Medicare payment for the mastectomy, creating potential billing disputes and financial risk for providers.
If Medicare payment is withheld for noncompliance, patients may face delays in receiving surgery while providers resolve documentation or payment issues, harming timely care.
The requirement to deliver and document the notice increases administrative burden and paperwork for providers, which could strain clinic workflows and staff time.
Based on analysis of 2 sections of legislative text.
Requires pre‑mastectomy notice that Medicare covers breast reconstruction, documents it in the medical record, and conditions Medicare payment on compliance.
Requires suppliers who perform mastectomies to tell patients before the procedure that Medicare covers breast reconstruction after medically necessary mastectomy, and to record that notice in the medical record. Medicare payment for the mastectomy is barred unless the pre-procedure notice was given and documented, and the rule takes effect one year after the law is enacted.
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