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Adds Medicare coverage and a payment formula for licensed/board‑certified genetic counselors for services on/after Jan 1, 2027, and excludes them from Medicare balance‑billing protections.
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
The bill expands Medicare coverage and direct access to genetic counseling and creates a new Medicare billing pathway for genetic counselors, but it shifts costs to beneficiaries via 20% coinsurance and may limit provider participation or create billing complexities due to payment caps and expedited rulemaking.
Medicare beneficiaries will be able to receive and have Medicare cover genetic counseling furnished directly by licensed or board‑certified genetic counselors beginning Jan 1, 2027, increasing access to specialized counseling for genetics-related care.
Licensed or board‑certified genetic counselors can bill Medicare directly, creating a clearer payment pathway that should encourage greater workforce participation and make it easier for providers to offer services to Medicare patients.
The bill sets an explicit allowable amount formula for genetic counseling billing (capping payment at a defined percentage of the physician fee schedule), which can limit excessive charges and provide more predictable pricing for patients and taxpayers.
Medicare beneficiaries will be responsible for 20% coinsurance on genetic counseling services, raising out‑of‑pocket costs for patients who need these services.
Paying genetic counselors at up to 85% of the physician fee schedule risks underpayment relative to current charges, which could reduce provider participation or limit access in some areas.
Changes to balance‑billing language or excluding genetic counselors from broader balance‑billing protections may create billing complexity and disputes between providers and beneficiaries, increasing the risk of surprise bills or administrative burdens.
Based on analysis of 2 sections of legislative text.
Adds Medicare coverage and payment rules for genetic counseling services furnished by licensed or board‑certified genetic counselors beginning January 1, 2027. Sets a payment formula (Medicare pays 80% of the lesser of the actual charge or 85% of the physician fee‑schedule amount that would have applied) and clarifies that other clinicians may still bill for genetic counseling services. Allows HHS to implement the changes by interim final rule with opportunity for comment and excludes genetic counselors from the Medicare balance‑billing protections that apply to physicians.