Sponsors (8)
The bill extends and clarifies Medicare coverage for medically necessary cranial prostheses, lowering costs for beneficiaries who can obtain clinician certification, but it creates new certification/documentation requirements that may delay care or deny coverage for those without access to certifying providers or proper paperwork.
Medicare beneficiaries with medically caused hair loss (e.g., from cancer, chemotherapy, or autoimmune disease) gain explicit Medicare coverage for cranial prostheses when a clinician certifies medical necessity.
Patients who receive a clinician-certified cranial prosthesis can face lower out-of-pocket costs because Medicare is authorized to pay for the item as durable medical equipment (DME).
Establishes a clear documentation pathway for clinicians and CMS (required written certification), which may streamline claims processing and reduce billing ambiguity when implemented correctly.
Medicare beneficiaries who lack access to the listed certifying providers may be denied coverage and face higher out-of-pocket costs for wigs/cranial prostheses.
If the required certifications are not properly completed, Medicare payments are explicitly prohibited, potentially increasing uncompensated costs for patients or providers.
Adds an administrative burden on clinicians and suppliers to obtain and retain written certifications, which could delay access to cranial prostheses and increase provider paperwork.
Based on analysis of 2 sections of legislative text.
Adds cranial prostheses (wigs) to Medicare durable medical equipment when a dermatologist, oncologist, or attending physician certifies medical necessity and makes lack of that certification a payment exclusion.
Adds cranial prostheses (wigs) to Medicare's definition of durable medical equipment when a dermatologist, oncologist, or attending physician certifies the item is medically necessary for rehabilitative treatment or hair loss from a health condition (including autoimmune disease, cancer, or chemotherapy). Requires a written certification for coverage and makes absence of that certification an express basis to deny Medicare payment. Creates a documentation requirement for suppliers and providers and amends Medicare payment rules to list failure to provide certification as a specific exclusion. No new appropriation, effective date not specified in the text provided.
Official title: To amend title XVIII of the Social Security Act to provide coverage for wigs as durable medical equipment under the Medicare program, and for other purposes.
Introduced February 12, 2026 by James P. McGovern · Last progress February 12, 2026