Medicare coverage of fertility treatment

(a) Coverage Section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) is amended— (1) in subparagraph (JJ), by inserting and after the semicolon at the end; and (2) by adding at the end the following new subparagraph: (KK) fertility treatment (as defined in section 2799A–11(b) of the Public Health Service Act);. (b) Payment and waiver of coinsurance Section 1833(a)(1) of the Social Security Act (42 U.S.C. 1395l(a)(1)) is amended— (1) by striking and before (HH); and (2) by inserting before the semicolon at the end the following:, and (II) with respect to fertility treatment (as described in section 1861(s)(2)(KK)), the amount paid shall be equal to 100 percent of the lesser of the actual charge for the treatment or the amount determined under the payment basis determined under section 1848. (c) Waiver of application of deductible The first sentence of section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is amended— (1) by striking, and (13) and inserting (13); and (2) by striking 1861(n).. and inserting 1861(n), and (14) such deductible shall not apply with respect to fertility treatment (as described in section 1861(s)(2)(KK)).. (d) Payment under physician fee schedule Section 1848(j)(3) of the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is amended by inserting (2)(KK), after risk assessment),. (e) Conforming amendment regarding coverage Section 1862(a)(1)(A) of the Social Security Act (42 U.S.C. 1395y(a)(1)(A)) is amended— (1) by striking or additional and inserting, additional; and (2) by inserting, or fertility treatment (as described in section 1861(s)(2)(KK)) after 1861(ddd)(1)). (f) Effective date The amendments made by this section shall apply to services furnished on or after January 1, 2026.