Genetic Counseling Reimbursement: Challenges and Solutions for Patient Access

Think billing for genetic counseling services is just about paperwork and numbers? Think again. In this eye-opening episode, we pull back the curtain on one of the most critical yet overlooked challenges facing genetic counselors today—getting fairly paid for their expertise.

Joined by billing expert Brian Reyes, MS, CGC from UT Southwestern Medical Center (speaking in his personal capacity), we dive into the perfect storm of obstacles preventing genetic counselors from being properly recognized and reimbursed. From outdated Medicare policies to missing dropdown menus in insurance systems, these seemingly small administrative issues create massive barriers to patient care. Brian shares his journey from billing-avoidant genetic counselor to passionate advocate, offering a masterclass in navigating these complex systems.

The conversation reveals a surprising truth: when genetic counselors can reach insurance decision-makers, they often find allies who understand the value genetic counselors bring to appropriate testing and patient care. The real challenge? Getting past gatekeepers to have these crucial conversations. We explore the new CPT code 96041 that finally recognizes the substantial behind-the-scenes work genetic counselors perform, and why this matters for sustainable practice.

Most powerfully, we reframe billing not as a tedious administrative task but as a fundamental equity issue. When genetic counseling centers don't bill for their services—whether through grant funding or giving up on reimbursement—they may inadvertently perpetuate a system where vulnerable populations lose access to critical genetic services. As Brian passionately argues, "Are we leaving money on the table that should rightly belong to the healthcare system for providing that service?"

Ready to advocate for change? Listen now to understand how the Access to Genetic Counseling Services Act could transform genetic counseling accessibility nationwide, and what steps you can take today to improve recognition and reimbursement in your practice.

Genetic Support Foundation: https://geneticsupportfoundation.org/

Lettercase National Center for Prenatal and Postnatal Resources: https://www.lettercase.org/