Access to Genetic Counselor Services Act of 2025
Summary
What This Bill Does
The Access to Genetic Counselor Services Act adds covered genetic counseling services to Medicare Part B. Covered services are genetic counseling services furnished on or after January 1, 2027, by a genetic counselor and related incident services the counselor is legally authorized to provide under State law or State regulatory mechanisms, when those services would otherwise be covered if furnished by a physician. A genetic counselor must be State-licensed or, in States without licensure, certified by the American Board of Genetic Counseling and meet any additional HHS criteria. The bill adds genetic counselors to the practitioner billing list and pays 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 furnished the services. It preserves the ability of physicians and other providers to bill for otherwise covered genetic counseling and lets HHS implement the changes through an interim final rule with comment period.
Who Benefits and How
Medicare beneficiaries who need genetic counseling benefit from direct access to covered services furnished by genetic counselors starting in 2027. Licensed and certified genetic counselors benefit from Medicare practitioner recognition and direct reimbursement. Physicians, oncology practices, prenatal care teams, and genetics clinics may benefit from clearer referral and billing pathways.
Who Bears the Burden and How
CMS and HHS must add genetic counselor enrollment, billing, payment, criteria, and rulemaking processes. Medicare may bear new Part B spending for covered genetic counseling services. Genetic counselors must satisfy State licensure or national certification requirements and comply with Medicare billing rules.
Key Provisions
- Adds covered genetic counseling services to Medicare Part B beginning January 1, 2027.
- Defines covered services by genetic counselors as services legally authorized under State law that would otherwise be covered if furnished by a physician.
- Defines genetic counselors by State licensure or American Board of Genetic Counseling certification in States without licensure.
- Adds genetic counselors to Medicare practitioner billing rules and sets payment at 80 percent of the lesser of actual charge or 85 percent of the physician fee schedule amount.
- Preserves billing by physicians and other providers for otherwise covered genetic counseling and authorizes interim final rulemaking.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Adds Medicare coverage and direct billing for covered genetic counseling services furnished by licensed or certified genetic counselors starting January 1, 2027.
Key Policy Areas
Healthcare, Medicare, Genetic Services
Primary Purpose
Adds Medicare coverage and direct billing for covered genetic counseling services furnished by licensed or certified genetic counselors starting January 1, 2027.
Policy Domains
Substantive provisions
Identified Gains
- Medicare beneficiaries needing genetic counseling
- Licensed genetic counselors
- Certified genetic counselors
- Genetics clinics
- Physician practices referring genetic counseling
Identified Costs
- Centers for Medicare and Medicaid Services
- Department of Health and Human Services
- Medicare program
- Genetic counselors entering Medicare billing
Sponsors
Legislative Progress
In CommitteeMr. Smith of Nebraska (for himself and Ms. Castor of …
Referred to the Committee on Energy and Commerce, and in …
Introduced in House
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Certified genetic counselors, Licensed genetic counselors, Medicare beneficiaries needing genetic counseling
Centers for Medicare and Medicaid Services, Medicare program
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology