Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Comprehensive Breast 
Reconstruction Act of 2021’’. 
SEC. 2. PROVIDING FOR HEALTH COVERAGE OF NIPPLE- 
AREOLAR COMPLEX TATTOOING IN CONNEC-
TION WITH RECONSTRUCTIVE SURGERY FOL-
LOWING 
MASTECTOMY; 
EXTENDING 
COV-
ERAGE OF BREAST RECONSTRUCTIVE SERV-
ICES 
FOLLOWING 
MASTECTOMY 
UNDER 
MEDICARE AND MEDICAID. 
(a) PRIVATE HEALTH INSURANCE COVERAGE AND 
GROUP HEALTH PLANS.— 
(1) IN GENERAL.—Section 713(a) of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1185b(a)) is amended— 
(A) in paragraph (2), by striking at the 
end ‘‘and’’; 
(B) in paragraph (3), by adding at the end 
‘‘and’’; 
(C) by inserting after paragraph (3) the 
following new paragraph: 
‘‘(4) tattooing of the nipple-areolar complex 
pursuant to or as part of such reconstruction if such 
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tattooing is performed by a physician, physician ex-
tender (as defined in section 1834(x) of the Social 
Security Act, or State-licensed tattoo artist (as de-
fined in such section), as prescribed by a physi-
cian;’’; and 
(D) by adding at the end of the flush mat-
ter following paragraph (4), as inserted by sub-
paragraph (C), the following: ‘‘Tattooing of the 
nipple-areolar complex described in paragraph 
(4) shall be deemed to be medically reasonable 
and necessary.’’. 
(2) EFFECTIVE DATES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sec-
tion shall apply with respect to plan years be-
ginning after the date of enactment of this Act. 
(B) SPECIAL RULE FOR COLLECTIVE BAR-
GAINING AGREEMENTS.—In the case of a group 
health plan maintained pursuant to 1 or more 
collective bargaining agreements between em-
ployee representatives and 1 or more employers 
ratified before the date of enactment of this 
Act, the amendments made by this section shall 
not apply to plan years beginning before the 
later of— 
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(i) the date on which the last collec-
tive bargaining agreements relating to the 
plan terminates (determined without re-
gard to any extension thereof agreed to 
after the date of enactment of this Act), or 
(ii) January 1 of the first year begin-
ning at least one year after the date of the 
enactment of this Act. 
For purposes of clause (i), any plan amendment 
made pursuant to a collective bargaining agree-
ment relating to the plan which amends the 
plan solely to conform to any requirement 
added by this subsection shall not be treated as 
a termination of such collective bargaining 
agreement. 
(b) MEDICARE COVERAGE.— 
(1) COVERAGE.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(A) in subparagraph (GG), by striking at 
the end ‘‘and’’; 
(B) in subparagraph (HH), by inserting at 
the end ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
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‘‘(II) qualifying reconstructive breast sur-
gery services (as defined in subsection (kkk)).’’. 
(2) DEFINITION.—Section 1861 of the Social 
Security Act (42 U.S.C. 1395x) is amended by add-
ing at the end the following new subsection: 
‘‘(kkk) QUALIFYING RECONSTRUCTIVE BREAST SUR-
GERY SERVICES.—The term ‘qualifying reconstructive 
breast surgery services’ means, in the case of an individual 
who has a mastectomy, breast reconstruction in connec-
tion with such mastectomy, including— 
‘‘(1) all stages of reconstruction of the breast 
on which the mastectomy has been performed; 
‘‘(2) surgery and reconstruction of the other 
breast to produce a symmetrical appearance; 
‘‘(3) prostheses and physical complications of 
mastectomy, including lymphedemas; and 
‘‘(4) tattooing of the nipple-areolar complex 
pursuant to or as part of such reconstruction if such 
tattooing is performed by a physician, physician ex-
tender, or State-licensed tattoo artist (as such terms 
are defined in section 1834(x), as prescribed by a 
physician; 
in a manner determined in consultation with the attending 
physician and the individual.’’. 
(3) PAYMENT.— 
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(A) IN GENERAL.—Section 1833(a)(1) of 
the Social Security Act (42 U.S.C. 1395l(a)(1)) 
is amended— 
(i) by striking ‘‘and (DD)’’ and in-
serting ‘‘(DD)’’; and 
(ii) by inserting before the semicolon 
at the end the following ‘‘ and (EE) with 
respect to qualifying reconstructive breast 
surgery services (as defined in section 
1861(kkk)), the amount paid shall be 
equal to the amount payable in accordance 
with section 1834(x)’’. 
(B) PAYMENT
DETERMINATION.—Section 
1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the 
following new subsection: 
‘‘(x) QUALIFYING RECONSTRUCTIVE BREAST SUR-
GERY SERVICES.— 
‘‘(1) IN GENERAL.—With respect to qualifying 
reconstructive breast surgery services described in 
section 1861(kkk)(4) for which payment is deter-
mined under this subsection, payment shall be made 
in an amount equal to 100 percent of the reasonable 
and customary amount for nipple areolar tattooing, 
determined according to the reimbursement rates for 
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