Medicare would cover genetic counseling from counselors who meet qualifications

Medicare would cover genetic counseling from counselors who meet the bill’s qualifications. Coverage would include genetic counseling and eligible related services and supplies. Counselors must hold a license in the state where they practice if that state licenses genetic counselors. In states without licensing, counselors must have American Board of Genetic Counseling certification and meet federal requirements. Related services and supplies must be allowed under state law and otherwise covered if provided by a physician or as part of a physician’s service. Other providers could still bill for genetic counseling that Medicare otherwise covers.

Medicare would pay 80 percent of the lower of the actual charge or 85 percent of the scheduled physician fee. The formula would apply to covered genetic counseling services. The physician fee would be the scheduled amount for the same service if a physician had provided it. The formula would apply to covered services provided on or after January 1, 2027.