Insurance Coverage for Genetic Counseling

 

Insurance Coverage for Genetic Counseling

 

PPO HMO Medicare and Tricare Medi-Cal Self-Pay
No referral or authorization needed in most cases.  

You must have a referral from your Primary Care Physician or Referring Physician. Please fax it to 415-885-3787 or bring it to the appointment.

Genetic counseling appointments are not covered by Medicare and Tricare. No referral or authorization needed. No referral or authorization needed.
We recommend you check with your insurance company to see if the billing codes below are covered and what your out-of-pocket cost will be. Your referring Physician is responsible for getting insurance authorization or out-of-pocket charges will apply. The cost for the visit will depend on the length of the visit. There is a 40% discount for self-pay patients. The cost of the visit starts at $190.80 for up to 44 minutes If you have a Managed Medi-cal HMO plan, please follow the steps listed under “HMO” The cost for the visit will depend on the length of the visit. There is a 40% discount for self-pay patients. The cost of the visit starts at $190.80 for up to 44 minutes
Make sure that your insurance has authorized payment for all our billing codes (see below). If not, please contact the doctor’s office that submitted the original request to have them modify the authorization. There is an ABN form that you will need to sign prior to meeting with your genetic counselor.

 

 

PLEASE MAKE SURE THAT YOUR AUTHORIZATION HAS THE FOLLOWING BILLING CODES (CPT CODES):   96040x6; 99001x1; 99205x1 AND 99215x1

 

RENDERING PROVIDER: UCSF MEDICAL CENTER OR DR. ROBERT NUSSBAUM

 

*Some managed Medi-cal plans do not recognize 96040. In that case, they use the code S0265.