The utilization of telehealth genetic counseling has exploded as a result of the COVID-19 pandemic. This has led to an increase in demand for secure technology by both clinics and companies offering third-party genetic counseling via telehealth. Although this has greatly increased access for genetic counseling services, it also presents challenges in terms of billing, credentialing, and licensure processes.
The NSGC Access and Service Delivery (ASD) Committee has been actively working on genetic counselors' behalf by advocating for federal recognition of genetic counselors as healthcare providers and reviewing the 96040 CPT code in order to better reflect the work genetic counselors do. Specifically the ASD Committee has focused on billing and reimbursement of the 96040 CPT code, which is a professional billing code that standardizes the medical services and procedures genetic counselors provide. This code became effective and available for use as of January 1, 2007. It is a time-based code, meaning that it is intended to be a stackable code for the amount of time spent face-to-face with a patient.
Many aspects of genetic counseling have changed since 2007; therefore, the NSGC ASD Committee has been actively working to investigate and consider how to revise the code to better reflect the current state of genetic counselor practice. The NSGC charges for 2022 asked the ASD Committee to evaluate options for updating the language for the 96040 CPT code. Below is a summary of our work so far:
- ASD investigated potential changes to the language of the code in consultation with other professional organizations and a coding consultant, Matthew Katz. Specifically, the work focused on updating the language used in 96040 to harmonize the code with more recently updated CPT codes.
- The Committee then proposed a revision that would better reflect how a genetic counselor’s time is spent, modernize the language, and help better define when the code can be used for reimbursement.
- Once drafted, the proposed revision underwent a feedback review cycle with stakeholder organizations including the American Academy of Pediatrics (AAP), American College of Obstetrics & Gynecology (ACOG), American College of Medical Genetics & Genomics (ACMG), American Society for Clinical Oncology (ASCO), and the College of American Pathologists (CAP).
- A preliminary application was submitted with co-sponsorship from ACMG to the CPT Committee of the American Medical Association (AMA) in June and is currently out for comments to the medical specialties that make up the AMA CPT editorial panel advisors.
- In September, Brian Reys (Vice Chair of ASD), Heather Zierhut (NSGC President), John Richardson (NSGC Director of Policy and Government Relations), Matthew Katz (Consultant, MCK Consulting, LLC), and Rachel Bluebond (Member, NSGC ASD Committee) will attend and present our proposed revisions to the AMA CPT committee.
These initiatives directly align with NSGC’s strategic plan through promoting growth and sustainability by increasing reimbursement for genetic counseling services. More importantly, these initiatives increase equitable access for those who would not otherwise receive these services.
There will be more details to follow and NSGC members will be updated as we have information to share. If you would like to learn how you can help with this effort, you can learn more on the NSGC website. If you have questions about the CPT code 96040 initiative specifically, please email Jennifer Trotter, NSGC Government Relations Manager.