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October 5, 2011

Genetic Counseling in Oncology—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts (ntung@bidmc.harvard.edu).

JAMA. 2011;306(13):1442-1443. doi:10.1001/jama.2011.1403

In Reply: Mr Buchanan and Ms Stopfer raise the issue of reimbursement for genetic counseling and propose a more accurate method by which to calculate the revenue generated by this service. Buchanan and Stopfer make the valid point that reimbursement for genetic counseling would likely be improved if Medicare recognized genetic counselors as providers. Progress toward reimbursing genetic counseling was made in January 2007 when the American Medical Association added a new Current Procedural Terminology code, 96040, for “Medical Genetics and Genetic Counseling Services.” Previously, genetic counseling could only be billed as an Evaluation and Management visit that required the presence of a physician to qualify for reimbursement from third-party payers. The impact of this new code is still uncertain. Although Medicare does not recognize genetic counselors as providers and therefore rejects this Current Procedural Terminology code, some have reported that many private insurance carriers are paying for genetic counselor–only visits.1 However, the reported success of billing using this code is variable, and physician-attended Evaluation and Management consults are reimbursed at higher rates for comparable time commitments.2 Medicare should recognize genetic counselors as providers so that each genetic counseling program can maximize its revenue and determine the financially optimal approach for its program to provide these services.