Sponsors (23)
The bill expands Medicare coverage and direct billing for genetic counselors—improving access to genetic counseling—while imposing coinsurance and payment limits that may raise out‑of‑pocket costs and risk reduced provider participation and fewer procedural protections for beneficiaries.
Medicare beneficiaries will gain direct access to covered genetic counseling services furnished by licensed or board‑certified genetic counselors starting January 1, 2027, expanding access to genetic risk assessment and counseling under Medicare.
Licensed or board‑certified genetic counselors can bill Medicare directly, creating a clearer payment pathway that is likely to increase workforce utilization and integration of genetic counseling into Medicare‑covered care.
The bill sets an explicit allowable amount formula for payment, which can restrain excessive charges and provide greater price predictability for patients and taxpayers.
Medicare beneficiaries will owe a 20% coinsurance on genetic counseling services, increasing out‑of‑pocket costs for patients who use these services.
Payment capped at 85% of the physician fee schedule may underpay genetic counselors relative to current charges, potentially reducing provider participation and access—especially in underserved or rural areas.
Altering balance‑billing language or excluding genetic counselors from broader balance‑billing protections could create billing complexity or disputes between providers and beneficiaries.
Based on analysis of 2 sections of legislative text.
Requires Medicare coverage and payment for genetic counseling by licensed/board‑certified genetic counselors from Jan 1, 2027, and sets a specific payment/coinsurance formula.
Introduced November 21, 2025 by Adrian Smith · Last progress November 21, 2025
Requires Medicare to cover genetic counseling services furnished by licensed or board‑certified genetic counselors beginning January 1, 2027, and establishes how Medicare will pay for those services. Payments are set so Medicare pays 80% of the lesser of the provider’s actual charge or 85% of the physician fee schedule amount that would have applied if a physician furnished the service; patients are responsible for the 20% coinsurance. The bill also extends Medicare balance‑billing protections to genetic counselors, allows the Department of Health and Human Services to implement the rules via an interim final rule with comment, and clarifies that other clinicians may continue to bill for genetic counseling services.