Access to Genetic Counselor Services Act of 2026

Medicare coverage for genetic counseling

If enacted, Medicare Part B would cover genetic counseling services starting January 1, 2027. Covered services would be those furnished by a qualifying genetic counselor. A qualifying counselor would be licensed by the State. In States without licenses, the counselor would need American Board of Genetic Counseling certification and Secretary-approved criteria. Services and supplies incident to the counseling would be covered if State law lets the counselor legally provide them and those services would otherwise be covered when furnished by a physician. Genetic counselors would be subject to Medicare balance-billing protections. Medicare would pay 80% of a determined allowed amount for these services. The allowed amount would be the lesser of the counselor's actual charge or 85% of the physician fee-schedule amount that would have applied if a physician had furnished the service. The Secretary could implement these changes by interim final rule with comment period. These changes would not stop physicians or other providers from billing Medicare for genetic counseling they already cover.