Sponsors (4)
The bill expands Medicare coverage and patient protections for genetic counseling—improving access and recognizing genetic counselors—while leaving beneficiaries responsible for coinsurance and imposing reimbursement and credentialing rules that could limit provider availability and public input on implementation.
Medicare beneficiaries will gain Medicare coverage for genetic counseling starting January 1, 2027, improving access to genetic risk assessment and care planning.
Medicare protections against surprise out-of-network billing will apply to genetic counseling, shielding beneficiaries from unexpected charges for these services.
Licensed or ABGC‑certified genetic counselors can bill Medicare, creating a new reimbursement pathway that is likely to increase demand for and recognition of the profession.
Medicare beneficiaries will owe a 20% coinsurance for genetic counseling, which could be a significant out‑of‑pocket cost for people who need frequent or high‑priced services.
Medicare reimbursement for genetic counseling is set at 85% of the comparable physician fee‑schedule amount, which may underpay counselors relative to private rates and reduce provider participation or availability.
Requiring state licensure or ABGC certification to bill Medicare may exclude some practitioners who provide genetic counseling but lack those credentials, potentially reducing access in some regions.
Based on analysis of 2 sections of legislative text.
Introduced January 8, 2026 by John A. Barrasso · Last progress January 8, 2026
Adds Medicare coverage and payment rules so genetic counseling services furnished by qualified genetic counselors are covered beginning January 1, 2027. It defines who qualifies as a genetic counselor, bars balance-billing by genetic counselors, sets a specific Medicare payment formula, and allows the Secretary to implement the changes by interim final rule with comment.