This bill, the Access to Genetic Counselor Services Act of 2025, would change Medicare rules to add coverage for "covered genetic counseling services" starting January 1, 2027. It adds a new definition of those services and defines who is a "genetic counselor": someone licensed by the State where they work, or, if the State does not license genetic counselors, someone certified by the American Board of Genetic Counseling and meeting any additional criteria the Secretary of Health and Human Services sets. The bill allows genetic counselors to bill Medicare for services and for supplies they are legally allowed to perform under state law. It adds genetic counselors to a provision related to balance billing protections. For payment, the bill says Medicare would pay 80 percent of the lesser of (a) the provider’s actual charge or (b) 85 percent of the physician fee schedule amount that would apply if a physician had furnished the service. The bill also says other providers may still bill Medicare for genetic counseling services when they otherwise would. The Secretary may implement these changes by an interim final rule with comment period.
If you are a Medicare Part B beneficiary, the bill would make genetic counseling services furnished by qualifying genetic counselors a covered Medicare service beginning in 2027. Genetic counselors who meet the bill’s definition could bill Medicare directly under these rules. The bill sets how Medicare would calculate payments for those services.
The bill specifies a payment formula: Medicare would pay 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount that would have applied if a physician had provided the service. The bill text does not include any estimates of total federal spending, program savings, or impacts on beneficiary out-of-pocket costs. No publicly available information on overall costs or budget estimates is provided in the bill text.
The bill’s text and title show that supporters seek to expand Medicare coverage and access to services furnished by genetic counselors, to allow genetic counselors to bill Medicare directly, and to set payment rules and balance-billing protections for those services.
No publicly available information.