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Genetic Counseling

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Andrea58:
Hello,
   I am looing for any information someone may have concerning genetic counseling and submitting the charge for this. Payers may not recognize the genetic counselor for their services, so I am reaching out to see how others may handle these services. Are you billing and writing off? Billing the patient? Not billing for this? Or billing and getting paid? Any guidance and or references you might be able to share is greatly appreciated.

Michele:
You can submit the charges, it will depend on whether or not the insurance carrier or the plan covers the services.  I would think you would bill the patient if not covered by their insurance, unless the provider is contracted with the insurance carrier and can't bill the patient per the contract.  But if the services aren't covered, usually the patient can be billed.   I have not ever billed for genetic counseling. 

PMRNC:
In most cases it's NOT covered. Even with cancer patient's such as myself where the genetic testing itself determines treatment it's not covered. In many cases cancer facilities and hospitals will have avenues for reimbursement due to grants and cancer organizations.

For testing, no it's NOT a normally covered service, but you could verify benefits for the testing to be sure. Genetic counseling and testing is still NOT fully considered medically necessary is the reason why it's normally a non covered benefit.

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