# Genetic Counseling - billing an E/M



## alysonrs (Oct 7, 2009)

Does anyone know anything about genetic counseling and if so how you are billing for these charges.  Currently our NP is doing the genetic counseling and we are billing an E/M for the service (which should be based on time).  Just wondering how other practices are handling these pt.

Any suggestions??? 

Thanks,


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## mlehmann (Oct 7, 2009)

*Gentic counseling*

There is a specific code for Genetic Counseling. It is 96040 and is billed once for every 30 minutes spent face to face with patient/family.


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## BoeJerger (Oct 8, 2009)

*genetic counseling*

In the past I have billed an office visit, new pt visit or consult depending on situation.  Billed for the amount of time and added V26.33 for the genetic counseling.  Never had and issue with payment but wondering if this was the accurate way to bill the genetic counseling service.


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## SThebarge (Oct 26, 2009)

We have found that only some payers will pay for the 96040, Medicare will not.  We have a genetic counselor and because she is auxillary staff we can only get reimbursed for a 99211.  If you are having the doctor or NP bill out based on time an E&M is correct.  Make sure it has the appropriate V84.xx code for genetic susceptibility to disease.  Hope this helps.


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## alysonrs (Oct 30, 2009)

Thank you for your help.  I thought with us billing under the NP that we could bill an E/M code based on time.  Thanks again.

Alyson


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## ATringle (Mar 11, 2013)

So you would bill 96040 under your MD or NP, for the Genetic Counselor?  I have an issue where our Genetic Counselor saw a patient inpatient.  How would I bill for that?  The MD did not see that patient that day....

Thanks 
Anita


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## jofoley (Jun 20, 2013)

*Documentation and Billing for Genetic Counselors*

Hi,
I was wondering if anyone could give me information on documentation and billing guidelines for Genetic Counselors?
Thanks,
Joann

For Consults, New/Established Office Visit


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## bolsen01 (Sep 12, 2013)

*Genetic Counseling Incident To*

Does anyone know if we can bill for the Genetic Counselor under the supervising physician, incident to, using CPT 96040 or S0265?  We cannot credential our GC and would like to bill for her services.

If we cannot use either of those codes under the supervising physician's name, then we want to bill an E&M. The question with this is:
Are we limited to 99211 when billing incident to the GC's services?
Can we bill a higher level E&M based on Time (most of the session is counseling?)

Thank you.


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## angelamhathcock (Jun 26, 2018)

*angelah*

We have been billing our 2 credentialed Genetic Counselors using code 96040, but many insurance companies are denying these claims. Should we be adding the the type of genetic testing we are doing along with the genetic counseling (what testing is being done, chromosomal, etc) as well or family history of disease? Just wondering if anyone has some advice on billing for these services. 

Thank you!
Angela


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## mkency (Jan 7, 2019)

*Genetic counseling and Billing an E/M*

1.	Genetic counseling billed under CPT 96040 is non-covered by Medicare and most other insurances, yet we continue to charge and bill.  Please validate genetic counseling is non-covered by our managed care payers.  Either we should stop charging 96040 or attach a zero charge and continue charging for productivity statistics.  Can we bill a facility charge (99212 – 99215) billed on a hospital claim form to capture revenue for genetic counseling?


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## TCamClark (Jan 9, 2020)

1. With Medicare can I used the GT Modifier with E/M 99211 for Telehealth service


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