S. 2760 — Reducing Hereditary Cancer Act of 2025

This section provides Medicare Part B coverage for germline mutation testing—defined as genetic testing for germline mutations associated with increased cancer risk, in accordance with evidence-based clinical practice guidelines from nationally recognized oncology professional organizations (e.g., National Comprehensive Cancer Network, American Society of Clinical Oncology)—for individuals with a personal or family history of a hereditary cancer gene mutation or a personal or family history suspicious for hereditary cancer. (Thus, such testing is excluded from coverage if performed more than once per individual.) The amendments apply to testing furnished on or after the date of enactment.

This section establishes Medicare coverage under Parts A and B for certain risk-reducing surgeries—deeming them reasonable and necessary notwithstanding the general exclusion in 42 U.S.C. 1862(a)(1)(A)—for individuals described in SSA §1861(s)(2)(KK) (i.e., those eligible for specified preventive services) for whom, based on evidence-based clinical practice guidelines described in SSA §1861(nnn), the surgery would reduce the risk of developing cancer. Applies to items and services furnished on or after the date of enactment.

This section establishes an exclusion from Medicare coverage restrictions (SSA section 1862(q)) for evidence-based screenings—such as screening mammography, breast screening MRI, colonoscopy, PSA testing, and other modalities recommended by clinical practice guidelines for high-risk individuals—for beneficiaries determined through genetic testing to have a hereditary cancer (germline) gene mutation. It requires the Secretary to increase applicable frequency limitations (or other coverage limits) to comply with evidence-based clinical practice guidelines under SSA section 1861(nnn) (or as determined appropriate), but not less frequently than annually. The section also amends the screening mammography payment provision (SSA section 1834(c)(2)(A)) to reference the new exclusion and applies to items and services furnished on or after enactment.