Sponsors (8)
The bill extends explicit Medicare coverage (and potential cost relief) for medically caused hair loss prostheses when clinicians certify medical necessity, but creates new certification requirements that may limit access or impose administrative and financial burdens if patients lack certifying providers or paperwork is incomplete.
Medicare beneficiaries with medically caused hair loss (e.g., from cancer treatment or autoimmune disease) gain explicit Medicare coverage for cranial prostheses when a clinician certifies medical necessity, which allows Medicare to pay for the item as durable medical equipment and can reduce patients' out-of-pocket costs.
Clinicians and CMS get a clear documentation pathway (required written certification) for certifying medical necessity, which may streamline claims processing and clarify billing/coverage decisions when the paperwork is provided.
Medicare beneficiaries in areas without access to the listed certifying providers (e.g., rural or underserved communities) may be denied coverage and face higher out-of-pocket costs for wigs and cranial prostheses.
Clinicians and suppliers face added administrative burdens to obtain and retain written certifications, which could delay patient access to prostheses and, if certifications are not properly completed, will prohibit Medicare payments and increase uncompensated costs for patients or providers.
Based on analysis of 2 sections of legislative text.
Treats cranial prostheses (wigs) as Medicare durable medical equipment when certified as medically necessary by a dermatologist, oncologist, or attending physician, and denies payment if that certification is not 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
Adds cranial prostheses (wigs) to the definition of durable medical equipment under Medicare when a dermatologist, oncologist, or attending physician provides a written certification that the prosthesis is medically necessary for rehabilitative treatment or hair loss caused by a health condition (including autoimmune disease, cancer, or chemotherapy). Creates an explicit Medicare payment exclusion if that required written certification is not provided, and adds minor punctuation edits to related payment-exclusion language.