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Genetic Counseling - billing an E/M

  1. #1
    Default Genetic Counseling - billing an E/M
    Exam Training Packages
    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???


  2. Default 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.

  3. #3
    Default 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.

  4. #4
    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.

  5. #5
    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.


  6. Default
    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....


  7. Default Documentation and Billing for Genetic Counselors
    I was wondering if anyone could give me information on documentation and billing guidelines for Genetic Counselors?

    For Consults, New/Established Office Visit

  8. #8
    Default 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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