Direct reimbursement available to genetic counselors, effective Jan. 1

Genetic counselors have the opportunity to participate in Blue Cross Blue Shield of Michigan’s Traditional and TRUST PPO (commercial) networks and Blue Care Network commercial, effective Jan. 1, 2022.

Participating genetic counselors can bill their professional services using codes *96040 and S0265. They can receive direct reimbursement for covered services within the scope of their licensure at 85% of the applicable fee schedule, minus any member deductibles and copayments. 

This change, effective for outpatient services provided on or after Jan. 1, affects Blue Cross and BCN benefit plans that cover services these providers are licensed to provide. To find out if a member has coverage, check web‑DENIS for member benefits and eligibility, or call Provider Inquiry at 1‑800‑344‑8525.

Requirements
Prior authorization isn’t required for genetic counseling services for any member. For BCN commercial members who have a primary care provider who is part of a medical care group based in the East or Southeast region, their primary care provider must submit a referral for a specialist office visit. Referrals aren’t required for other members.

Enrollment forms
Genetic counselors can find enrollment forms and practitioner agreements at bcbsm.com/providers. To find enrollment information, click on Enroll to become a provider. Specific qualification requirements are identified within each agreement.

All applicants must pass a credentialing review before participation. We’ll notify applicants in writing of their approval status.

Background
Genetic counselors obtain and evaluate individual, family and medical histories to determine the risk for genetic or medical conditions or diseases in a client, the client’s descendants or other family members of the client. Genetic counselors explain to the client the clinical implications of genetic laboratory tests and other diagnostic studies, as well as their results.

Medical policy
Refer to the Blue Cross and BCN medical policy titled “Genetic Testing and Counseling” for more information.