Sponsors (5)
The bill expands Medicare coverage and reduces costs for medically caused hair loss prostheses when clinicians provide a required written certification, but tying coverage to that certification creates administrative hurdles and risks of coverage gaps or denied payments for some beneficiaries and providers.
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.
Medicare beneficiaries 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).
Clinicians and CMS get a clear written-certification documentation pathway, which should streamline claims processing and reduce billing ambiguity when the required certification is provided.
If certifications are incomplete or improperly completed, Medicare payments are explicitly prohibited, increasing the risk of uncompensated costs for patients or providers.
Medicare beneficiaries who lack access to the listed certifying providers (or whose clinicians will not provide the written certification) may be denied coverage and face higher out-of-pocket costs for wigs.
Requiring written certifications adds administrative burden on clinicians and suppliers, which could delay patient access to cranial prostheses.
Based on analysis of 2 sections of legislative text.
Adds cranial prostheses (wigs) to Medicare durable medical equipment when a qualifying physician certifies medical necessity; lack of that certification disallows payment.
Adds cranial prostheses (wigs) to the federal definition of durable medical equipment for Medicare when a dermatologist, oncologist, or attending physician provides a written certification that the prosthesis is medically necessary for rehabilitative treatment or hair loss from a health condition (including autoimmune disease, cancer, or chemotherapy). It also creates an explicit exclusion from Medicare payment if that required written certification is not provided, and adjusts related statute punctuation to accommodate the new rule.
Introduced February 12, 2026 by James P. McGovern · Last progress February 12, 2026