Genetic Counseling Program

Untitled Document

Billing, Reimbursement, and Barriers of the Genetic Counseling CPT Code:  The North Carolina Experience.  By Rebecca Fowler

Capstone Project Committee: Randi Culp Stewart, MS, CGC (UNCG), Chair; Carolyn Wilson-Brackett, MS, CGC (Fullerton Genetics Center); Stephanie Bollinger (Fullerton Genetics Center) and Sat Gupta, PhD (UNCG), Statistical Consultant

Background:  In 2007, the American Medical Association introduced the 96040 CPT code to bill for “Medical Genetics and Genetic Counseling Services”.    Harrison et al. showed that a minority of counselors were billing using this code and many had encountered significant barriers in billing (2007).  Purpose:  The goal of this study was to investigate the billing practices of genetic service providers in North Carolina, to assess reimbursement for use of the genetic counseling CPT code, and to identify primary barriers to use of the code.  Methods:  Genetic service providers that are members of the North Carolina Medical Genetics Association were surveyed and one billing and reimbursement specialist was interviewed.  Descriptive statistics were used to assess for trends in the data, and t-test analyses were performed to assess for associations.  Results:  Twenty-one respondents completed the survey.  Fourteen (67%) indicated that their institution was currently billing using the code.  Respondents reported significantly higher billing knowledge than reimbursement knowledge.  The most commonly indicated reasons for not billing with the code included lack of state licensure, employer policies that prevent counselors from billing independently, and the perceived lack of reimbursement.  The majority of respondents reported that increasing usage and consistency of the code would benefit genetic counselors (81%) and patients (76%).  The interviewee suggested that a significant barrier to use of the code was poor reimbursement and advocating for better reimbursement was recommended.  Conclusion:  While most respondents reported billing using the genetic counseling CPT code, there are significant barriers to use of the code.  Efforts to improve reimbursement and obtain licensure for genetic counselors in North Carolina may help address these barriers.  Further research is needed to clarify reimbursement rates and reasons for denials, and to assess whether the code is used more often in states with licensure for genetic counselors.

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  • "I chose to attend UNCG because of its shared learning environment and the access to some of the leading institutions in the country. "

  • "UNCG is a great fit for me. The program directors have extensive experience in the world of genetic counseling and provide you with opportunities to work with some of the best medical centers in the country. Our location allows us to have expert guest lecturers, many of whom you also get to work alongside or observe in your clinical rotations in your second year. We also have some really wonderful and unique opportunities as a part of this program: we observe in syndrome specific support groups and clinics, tour genetic laboratories, and are matched with a family with a genetic disease to learn what it is like to live with a genetic condition. Finally, our directors are genuinely invested in each of us, and care about our success and getting to know each of us personally."

  • "The director and assistant director do their best to ensure that our program provides a collaborative learning experience.  Both are active members of the Genetic Counseling community and strive to introduce you to all aspects of this field.  We also have renowned clinical sites and the beautiful state of North Carolina at our disposal.”