Medicare Insurance Coverage for Genetics

Medicare Coverage for Genetic Counseling and Testing Genetic Counseling

At UCSF and most other major hospitals, genetic counselors are the professionals who coordinate genetic testing. Genetic counselors have Master’s degrees, have passed a national board exam, and are licensed by the State of California. Your genetic counselor will study your family history, explain genetic testing, and help you decide whether genetic testing is right for you and your family. The counselor will choose the best test for you and coordinate the test send-out. The counselor will also help interpret the test results.

At this time, Medicare does not pay UCSF for the services of the genetic counselors.

Therefore, patients with insurance through Medicare are asked to self-pay for their appointment. We are able to offer a 40% discount compared to the usual cost. The visit is billed based on the length of time, starting at $227.40 for a visit up to 44 minutes. If you have genetic testing, an additional $54.00 sample processing fee will be charged.

At the time of your visit, you will be asked to sign a form called an Advance Beneficiary Notice (ABN) to acknowledge that Medicare does not pay for this service.

Some secondary insurance policies will cover genetic counseling, and others will not. If you have questions, you can ask your insurance company if the CPT code 96040 is covered. You can also call our office for more information at 415-885-7779.

If you have a family member who would like to attend genetic counseling, and that family member has commercial insurance that covers the CPT code 96040, you could choose to attend an appointment together and register the appointment under your family member, rather than you.

Genetic Testing

Medicare will pay for genetic testing for people who meet specific criteria based on their own cancer history and the cancer in their family. We can do a preliminary review of your history before the appointment, so you know whether testing is likely to be covered or not. After studying your medical records and family history during the appointment, the genetic counselor will be able to tell more clearly whether your testing will be covered or not.

If your genetic testing is not covered by Medicare, but you still want the testing, you may choose to pay for the testing yourself. In that case, the genetic counselor will review self-pay options with you.

UCSF Cancer Genetics and Prevention Program February 2017