Sponsors (25)
The bill extends Medicare coverage and a billing pathway for licensed genetic counselors—improving access and price predictability—but shifts costs to beneficiaries, risks undercompensating providers (which could limit access), and shortens initial public rulemaking time.
Medicare beneficiaries will gain direct access to covered genetic counseling furnished by licensed or board‑certified genetic counselors starting Jan 1, 2027, improving access to genetic expertise for diagnosis, care planning, and prevention.
Licensed or board‑certified genetic counselors will be able to bill Medicare directly, creating a clearer payment pathway that is likely to expand workforce utilization and make counseling services more available.
Medicare beneficiaries and taxpayers will get greater price predictability because the bill sets an explicit allowable amount formula that limits provider billing and can restrain excessive charges.
Medicare beneficiaries will owe 20% coinsurance for genetic counseling services, increasing out‑of‑pocket costs for patients who use these services.
Patients (including those with chronic conditions) and Medicare beneficiaries may face reduced access if the payment cap at 85% of the physician fee schedule underpays genetic counselors and discourages provider participation, especially in underserved areas.
Medicare beneficiaries and genetic counselors may face billing complexity or disputes because the bill excludes genetic counselors from broader balance‑billing protections or alters balance‑billing language.
Based on analysis of 2 sections of legislative text.
Allows licensed/board-certified genetic counselors to bill Medicare for counseling starting Jan 1, 2027, with Medicare paying 80% of the lesser of the charge or 85% of the physician fee schedule amount.
Official title: To amend title XVIII of the Social Security Act to provide for expanded coverage of services furnished by genetic counselors under part B of the Medicare program, and for other purposes.
Introduced November 21, 2025 by Adrian Smith · Last progress November 21, 2025
Adds Medicare coverage and payment rules so licensed or board-certified genetic counselors can bill Medicare for genetic counseling services furnished on or after January 1, 2027. Sets a specific Medicare payment method (Medicare pays 80% of the lesser of the provider's charge or 85% of the physician fee schedule amount), allows HHS to use an interim final rule to implement the change, and clarifies other clinicians may still bill for genetic counseling while removing balance-billing protections for genetic counselors. The change alters several Medicare statutory provisions to define genetic counseling services as covered when furnished by credentialed genetic counselors and creates a tailored payment formula that likely lowers payment relative to physician rates while establishing beneficiary cost-sharing rules and administrative rulemaking authority for HHS.