Medicaid Coverage of Genetic Counseling

Effective January 1, 2011, Medicaid will cover genetic counseling when provided by a certified or credentialed genetic counselor. Genetic counseling services may be provided in a practitioner’s office or in an Article 28 hospital outpatient department (OPD) or free-standing diagnostic and treatment center (D&TC). Reimbursement will be made to physicians, nurse practitioners, licensed midwives and Article 28 clinics who employ or contract with the genetic counselors. Genetic counselors must be certified by the American Board of Genetic Counseling (ABGC), the American Board of Medical Genetics (ABMG) or be an advanced practice nurse in genetics (APNG), who is credentialed by the Genetic Nursing Credentialing Commission (GNCC). A written order is required. Genetic counseling provided by a genetic counselor is billed under CPT code 96040 (Genetic Counseling). When genetic counseling is provided by a physician, the appropriate Evaluation and Management code should be used instead of CPT code 96040. Claims should include the diagnosis code that most closely describes the reason for the counseling. Source: December 2010 Medicaid Update