Agencies
Services
Provider Notice issued 10/14/08
- S3818 – BRCA1 Analysis
- S3819 – BRCA2 Analysis
- S3820 – Complete BRCA1 and BRCA2 Analysis
- S3820QP – Reflex BRCA Analysis
- S3822 - BRCA Analysis Single Mutation
- S3823 – BRCA Analysis Three Mutation
To: Participating Physicians, Hospitals and Laboratories
Date: October 14, 2008
Re: Reimbursement for Genetic Counseling Services Rendered by Genetic Counselors
In the near future, the department plans to propose rulemaking that will allow genetic counselors to enroll with the department and bill for their services. In the interim, effective with dates of service on or after October 1, 2008, physicians may submit bills for genetic counseling services rendered by a genetic counselor, as long as such practice is not in conflict with the Genetic Counselor Licensing Act [225 ILCS 135].
When billing for the services of a genetic counselor, physicians will use CPT code 96040 and will be reimbursed at a rate of $40.20 per counseling session. If additional services are rendered that day, a physician may also bill the appropriate Evaluation and Management CPT code for their professional services.
The department will also be opening the following breast cancer genetic testing procedure codes:
Your participation in our programs is greatly appreciated. Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs