Sponsors (16)
The bill extends Medicare coverage and consumer protections to genetic counseling—improving access and reducing surprise bills for beneficiaries—while relying on capped Medicare payments, state/certification eligibility rules, and expedited rulemaking that may reduce provider participation, create uneven access across states, and cause billing confusion.
Medicare beneficiaries will have direct Medicare coverage for genetic counseling beginning Jan 1, 2027, improving access to genetic risk assessment and personalized care and lowering many out-of-pocket costs for those services.
State-licensed or ABGC-certified genetic counselors can bill Medicare directly, expanding workforce utilization and likely increasing the availability of counseling services for patients.
Adding genetic counselors to balance-billing protections reduces surprise billing risk for Medicare beneficiaries who receive counseling services.
Medicare payment is capped (85% of physician fee schedule, with Medicare covering 80% of the allowed amount), which may be lower than current private pay rates and could discourage some providers from offering genetic counseling to Medicare patients.
States that do not license genetic counselors will rely on ABGC certification and HHS criteria for provider eligibility, creating the risk of uneven access and eligibility across states.
Because physicians and other providers may still bill for genetic counseling, there could be billing duplication disputes or confusion over which provider should bill and at what reimbursement rate.
Based on analysis of 2 sections of legislative text.
Requires Medicare coverage and sets payment rules for genetic counseling by licensed or ABGC-certified genetic counselors, effective Jan 1, 2027.
Introduced November 21, 2025 by Adrian Smith · Last progress November 21, 2025
Makes Medicare cover genetic counseling services provided by licensed or ABGC-certified genetic counselors starting January 1, 2027, and sets a specific Medicare payment method for those services. It defines covered genetic counseling services and genetic counselor, extends Medicare balance-billing protections to genetic counselors, allows interim final rulemaking, and preserves physicians' ability to bill for the same services.