Access to Genetic Counselor Services Act of 2025
Sponsored By: Representative Smith (NE)
Introduced
Summary
Expands Medicare Part B to cover genetic counseling services provided by qualified genetic counselors. This change would create a new covered service category, define who counts as a genetic counselor, set a specific payment formula, and apply to services furnished on or after January 1, 2027.
Show full summary
- Medicare beneficiaries: Would gain direct coverage of genetic counseling when provided by state-licensed genetic counselors or American Board of Genetic Counseling (ABGC) certified counselors who meet Secretary-established criteria, including supplies incident to counseling, starting January 1, 2027.
- Genetic counselors and providers: Would be eligible to bill Medicare directly and receive payment equal to 80% of the lesser of the actual charge or 85% of the physician-fee-schedule amount that would apply if a physician had furnished the service.
- Program rules and flexibility: Expands balance-billing protections to include genetic counselors, preserves physicians' ability to bill for genetic counseling services, and authorizes the Department of Health and Human Services Secretary to implement the policy by an interim final rule with comment.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Medicare coverage for genetic counseling visits
If enacted, Medicare would cover genetic counseling visits starting January 1, 2027. Coverage would apply when the visit is with a state-licensed genetic counselor, or with an American Board of Genetic Counseling–certified counselor in states without licensure, plus any extra criteria the Health and Human Services Secretary sets. Supplies and services that go with the visit could also be covered if state law allows the counselor to do them and Medicare would cover them when done by a doctor. Doctors and other providers could still bill for genetic counseling when those services are otherwise covered, and genetic counselors would be named in Medicare billing rules. HHS could set the rules quickly through an interim final rule with a public comment period.
Medicare pay rates for genetic counseling
Starting January 1, 2027, Medicare would pay for genetic counseling using a set formula. Medicare would pay 80% of the lesser of: the provider’s actual charge, or 85% of the amount that would apply if a physician provided the same service. This formula would set the allowed payment per visit.
Sponsors & CoSponsors
Sponsor
Smith (NE)
NE • R
Cosponsors
Castor (FL)
FL • D
Sponsored 11/21/2025
Neguse
CO • D
Sponsored 12/23/2025
Vindman
VA • D
Sponsored 1/9/2026
Davis (NC)
NC • D
Sponsored 1/13/2026
Crow
CO • D
Sponsored 2/24/2026
Raskin
MD • D
Sponsored 3/4/2026
Gottheimer
NJ • D
Sponsored 3/4/2026
Bilirakis
FL • R
Sponsored 3/4/2026
DelBene
WA • D
Sponsored 3/4/2026
Lawler
NY • R
Sponsored 3/4/2026
Swalwell
CA • D
Sponsored 3/4/2026
Dean (PA)
PA • D
Sponsored 3/4/2026
Tonko
NY • D
Sponsored 3/25/2026
Roll Call Votes
No roll call votes available for this bill.
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