Medicare Breast Reconstruction Access and Information Act

This introduced bill, the Medicare Breast Reconstruction Access and Information Act, would change how Medicare pays for mastectomies by tying payment to information and record-keeping about breast reconstruction. Specifically, it would add a requirement to inform patients undergoing a medically necessary mastectomy that breast reconstruction after such a mastectomy is covered by Medicare under national coverage determination (NCD) 140.2, and to document that information in the patient’s medical record. Payment for the mastectomy would not be made unless these steps are completed. The requirement would take effect for mastectomies performed one year after enactment. The bill is sponsored in the House by Representatives Waters and a group of co-sponsors and has been referred to the relevant committees. In short, the bill aims to ensure patients are informed about Medicare coverage for reconstruction after mastectomy and to formalize that information in their medical records as a condition of Medicare payment.