CPT codes 11920, 11921, and 11922 (or any suc-
cessor to such codes). 
‘‘(2) REASONABLE
AND
NECESSARY
TREAT-
MENT.—Qualifying reconstructive breast surgery 
services described in section 1861(kkk)(4) shall be 
deemed to be reasonable and necessary for purposes 
of section 1862(a)(1)(A). 
‘‘(3) PHYSICIAN EXTENDER.—For purposes of 
this subsection and section 1861(kkk)(4), the term 
‘physician extender’ means a health care practitioner 
who is not a physician and who is licensed or cer-
tified by the State in which the practitioner if fur-
nishing services to furnish items or services typically 
furnished by a physician, such as a nurse practi-
tioner or physician assistant. 
‘‘(4) STATE-LICENSED
TATTOO
ARTIST.—For 
purposes 
of 
this 
subsection 
and 
section 
1861(kkk)(4), the term ‘State-licensed tattoo artist’ 
means an individual (as specified by the law of the 
State in which the individual is licensed in per-
forming permanent body art and in which they are 
so practicing such art) who maintains all public 
health, safety, and welfare standards and regulations 
set forth by the State, including all sterilization, 
sanitation, and safety regulations for tattoo parlors 
VerDate Sep 11 2014 
16:11 Feb 13, 2021
Jkt 019200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H469.IH
H469
pamtmann on DSKBC07HB2PROD with BILLS
and salons, tattoo inks, tattoo instruments, and any 
other related paraphernalia, as well as allowing the 
individual to perform the procedure in the pre-
scribing physician’s place of business with the con-
sent of the physician and the patient, abiding by all 
such standards and regulations.’’. 
(4) INCLUDING CERTAIN TATTOO ARTISTS AS 
MEDICARE
PROVIDERS
FOR
PURPOSES
OF 
TATTOOING
OF
THE
NIPPLE–AREOLAR
COMPLEX 
AFTER MASTECTOMY.—Section 1866(j)(1) of the So-
cial Security Act (42 U.S.C. 1395cc(j)(1)) is amend-
ed by adding at the end the following new subpara-
graph: 
‘‘(D) INCLUDING
CERTAIN
TATTOO
ART-
ISTS
FOR
PURPOSES
OF
TATTOOING
OF
THE 
NIPPLE–AREOLAR
COMPLEX
AFTER
MASTEC-
TOMY.—For purposes of this section, the term 
‘supplier’ shall include a State-licensed tattoo 
artist (as defined in section 1834(x)), but only 
with respect to the tattooing of the nipple- 
areolar complex pursuant to or as part of re-
constructive surgery following a medically nec-
essary mastectomy and if such tattooing is pre-
scribed by a physician.’’. 
VerDate Sep 11 2014 
16:11 Feb 13, 2021
Jkt 019200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H469.IH
H469
pamtmann on DSKBC07HB2PROD with BILLS
(5) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to items 
and services furnished on or after January 1 of the 
first year beginning after the date of the enactment 
of this Act. 
(c) MEDICAID COVERAGE.— 
(1) IN GENERAL.—Section 1905(a) of the So-
cial Security Act (42 U.S.C. 1396d(a)) is amend-
ed— 
(A) by redesignating paragraph (30) as 
paragraph (31); 
(B) in paragraph (29), by striking at the 
end ‘‘and’’; 
(C) by inserting after paragraph (29) the 
following new paragraph: 
‘‘(30) qualifying reconstructive breast surgery 
services (as defined in section 1861(kkk)); and’’; and 
(D) by adding at the end of the flush mat-
ter following paragraph (31), as redesignated 
by subparagraph (A), the following new sen-
tence: ‘‘For purposes of paragraph (30), quali-
fying reconstructive breast surgery services de-
scribed in section 1861(kkk)(4) shall be deemed 
to be medically reasonable and necessary.’’. 
(2) EFFECTIVE DATE.— 
VerDate Sep 11 2014 
16:11 Feb 13, 2021
Jkt 019200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H469.IH
H469
pamtmann on DSKBC07HB2PROD with BILLS
(A) IN
GENERAL.—Subject to subpara-
graph (B), the amendments made by this sec-
tion shall take effect with respect to medical as-
sistance provided on or after January 1 of the 
first year beginning after the date of the enact-
ment of this Act. 
(B) EXCEPTION
FOR
STATE
LEGISLA-
TION.—In the case of a State plan under title 
XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) that the Secretary of Health and 
Human Services determines requires State leg-
islation in order for the respective plan to meet 
any requirement imposed by the amendments 
made by this section, the respective plan shall 
not be regarded as failing to comply with the 
requirements of such title solely on the basis of 
its failure to meet such an additional require-
ment before the first day of the first calendar 
quarter beginning after the close of the first 
regular session of the State legislature that be-
gins after the date of the enactment of this Act. 
For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative ses-
sion, each year of the session shall be consid-
VerDate Sep 11 2014 
16:11 Feb 13, 2021
Jkt 019200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H469.IH
H469
pamtmann on DSKBC07HB2PROD with BILLS
ered to be a separate regular session of the 
State legislature. 
Æ 
VerDate Sep 11 2014 
16:11 Feb 13, 2021
Jkt 019200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6301
E:\BILLS\H469.IH
H469
pamtmann on DSKBC07HB2PROD with BILLS