The Access to Genetic Counselor Services Act: What Would Change for Medicare Billing
Short answer: The Access to Genetic Counselor Services Act — S.3607, introduced in the Senate on January 8, 2026, and its House companion H.R.6280, reintroduced November 25, 2025 — would let certified genetic counselors bill Medicare Part B directly, at 80% of the lesser of the actual charge or 85% of the physician fee schedule, effective January 1, 2027 if enacted. Nearly identical bills have been introduced in five Congresses since 2018 and have never received a floor vote.
A Decade of Reintroduction
Genetic counselors have been asking Congress for direct Medicare billing rights since at least 2018, when H.R.7083 became the first version of the Access to Genetic Counselor Services Act. It did not advance. The bill returned as H.R.3235 in 2019 with 17 bipartisan cosponsors (10 Democrats, 7 Republicans), and GenomeWeb's coverage at the time counted more than 250 supporting organizations, including genetic testing companies such as Quest Diagnostics, LabCorp, Myriad Genetics, Invitae, Ambry Genetics, and ARUP Laboratories, alongside cancer centers like Memorial Sloan Kettering and Moffitt. That version also stalled. Subsequent reintroductions followed in the 117th Congress as H.R.2144 (2021) and the 118th Congress as S.2323/H.R.3876 (2023). None reached a floor vote in either chamber.
The current attempt splits across two bills in the 119th Congress: H.R.6280, reintroduced by Reps. Kathy Castor (D-FL) and Adrian Smith (R-NE) on November 25, 2025, and S.3607, introduced by Sen. John Barrasso (R-WY) on January 8, 2026 with cosponsors Sen. Peter Welch (D-VT), Sen. Shelley Moore Capito (R-WV), and Sen. Jacky Rosen (D-NV). Both carry the same official purpose: to amend Title XVIII of the Social Security Act to expand Medicare Part B coverage of services furnished by genetic counselors.
What S.3607 and H.R.6280 Would Actually Do
Under current law, Medicare Part B does not recognize genetic counselors as billing providers at all. A physician (or, depending on state scope-of-practice rules and payer policy, certain other practitioners) must bill for the genetic counseling encounter, regardless of who in the room actually has the genetics training. The bills would change that in four specific ways: certified genetic counselors could enroll in Medicare and bill Part B directly for their own services; Medicare would pay 80% of the lesser of the counselor's actual charge or 85% of the applicable physician fee schedule amount — the same reimbursement formula Medicare already uses for physician assistants and nurse practitioners; counselors could not balance-bill patients above the Medicare-approved amount; and existing incident-to billing arrangements, where a counselor's work is billed under a supervising physician, would remain available rather than being displaced. If enacted before the date, coverage would begin January 1, 2027.
The CPT Change That Already Happened: 96041
While the Access to Genetic Counselor Services Act has stalled in Congress, the billing code underneath genetic counseling encounters did change. Effective January 1, 2025, CPT 96041 replaced CPT 96040, the code created back in 2007 for "medical genetics and genetic counseling services." According to the National Society of Genetic Counselors' own analysis, 96041 removes the strict face-to-face time requirement, letting counselors capture preparatory chart review and same-day follow-up work that 96040 could not bill. NSGC estimated that 93.2% of genetic counselors would benefit from the change, with an average of 1.54 additional billable time units per consultation.
That is a real improvement — but it is a CPT coding change, not a Medicare coverage mandate. CPT codes describe what a service is; they do not by themselves determine who Medicare will pay for performing it. Because Medicare still does not recognize genetic counselors as Part B billing providers, 96041's added time-capture mostly benefits commercial payers and the state Medicaid programs that already recognize genetic counselors directly. It does nothing to change Medicare's physician-only billing rule. That is precisely the gap S.3607 and H.R.6280 are written to close.
Why It Keeps Stalling: The Scope-of-Practice Fight
The Access to Genetic Counselor Services Act has never lacked bipartisan sponsors or industry support. What it has lacked is agreement from every corner of clinical genetics. The National Society of Genetic Counselors and the American Society of Human Genetics have consistently backed it, and GenomeWeb's 2019 reporting on the H.R.3235 version counted support from over 250 organizations, including major reference laboratories and cancer centers. The recurring holdout has been the American College of Medical Genetics and Genomics, which has withheld support absent explicit bill language preventing genetic counselors from ordering genetic tests independently of a supervising physician. ACMG's position, per that same reporting, is that physicians should retain authority over test interpretation; NSGC's counter is that state licensure law, not federal Medicare reimbursement statute, is the appropriate place to define a counselor's scope of practice — and that research cited in the 2019 debate found meaningful cost savings, on the order of $48,000 in one study, when genetic counselors reviewed test orders before they went out.
Neither side has moved. That unresolved disagreement, more than any funding or scoring objection, is the most plausible reason six bill numbers across five Congresses have yet to reach a floor vote in either chamber.
What Labs, Medical Directors, and RCM Teams Should Do Now
Nothing changes for Medicare billing today. Genetic counselors still cannot enroll in or bill Medicare Part B directly under current law, regardless of what CPT 96041 allows with other payers. A few concrete steps are worth taking while the bill sits in committee rather than waiting for a floor vote that may not come:
- Keep Medicare billing as-is. Continue routing Medicare Part B genetic counseling claims through a billing physician or an approved incident-to arrangement until either bill is actually signed into law — introduction is not enactment, and this bill has failed five times before.
- Confirm CPT 96041 adoption payer by payer. Since the code change already took effect in January 2025, verify which of your commercial and Medicaid payers have updated their fee schedules and prior-authorization logic to recognize 96041 rather than the deleted 96040, and flag any that still deny or downcode it.
- Check state-level scope-of-practice and Medicaid rules directly. Recognition and reimbursement for genetic counselors already vary by state independent of federal law; confirm your state's current licensure and Medicaid billing rules with NSGC's billing and reimbursement resources or your state genetic counselors association rather than assuming Medicare parity.
- Watch for committee action, not just bill introduction. Track S.3607 in Senate Finance and H.R.6280 in House Energy & Commerce and Ways & Means for markup or hearing activity, which would be a meaningfully stronger signal than the introduction itself.
- Model the 2027 scenario without committing to it. If your organization employs or contracts with genetic counselors, it's reasonable to sketch what direct Medicare billing at 85% of the physician fee schedule would mean for revenue and staffing — as a contingency, not an assumption.
For related coverage of how Medicare oversight of genetic testing is intensifying more broadly, see our analysis of the OIG's 2026 Medicare Part B genetic testing audit, and for the billing-access side of the equation, our guide to prior authorization trends in genetic testing. Both intersect with the same documentation and provider-recognition questions this bill is trying to resolve. Visit the ScreenMyGene homepage for more coverage and coding resources.
Educational Disclaimer
This article summarizes pending federal legislation and a completed CPT coding change as of September 2026 for general information for laboratory, medical-director, genetic-counseling, and revenue-cycle audiences. It is not legal, billing, or coding advice for any specific organization or claim. S.3607 and H.R.6280 are proposed bills, not enacted law, and Congress has not passed any version of this legislation across five prior attempts since 2018; their provisions, including the proposed January 1, 2027 effective date, could change, stall again, or never be enacted. Verify current bill status directly against Congress.gov and consult qualified reimbursement, compliance, or healthcare counsel before making billing or staffing decisions based on this legislation. This content is not diagnostic or treatment guidance for any patient.
Sources: S.3607, Access to Genetic Counselor Services Act of 2026, introduced January 8, 2026 (Congress.gov, GovInfo, and Sen. Barrasso's office bill summary); H.R.6280, Access to Genetic Counselor Services Act of 2025, reintroduced November 25, 2025 (Rep. Castor's office press release, November 25, 2025); Sen. Peter Welch's office, press release on S.3607 (January 12, 2026); GenomeWeb, "Genetic Counselors Medicare Payment Bill Gaining Support Despite 'Scope of Practice' Disagreement" (2019) and "New Billing Code for Genetic Counselors Will Better Capture Time Spent on Patients, NSGC Says"; National Society of Genetic Counselors, CPT 96041 billing and reimbursement analysis; Congress.gov records for H.R.7083 (115th Congress), H.R.3235 (116th Congress), H.R.2144 (117th Congress), and S.2323/H.R.3876 (118th Congress).
Frequently Asked Questions
What is the Access to Genetic Counselor Services Act?
It's bipartisan legislation — currently S.3607 in the Senate and H.R.6280 in the House — that would let certified genetic counselors bill Medicare Part B directly for their services, at 85% of the physician fee schedule, rather than requiring a physician to bill on their behalf. It has been introduced in five Congresses since 2018 without passing.
Can genetic counselors bill Medicare directly today?
No. Under current law, Medicare Part B does not recognize genetic counselors as billing providers. Services must be billed by a physician or through an approved incident-to arrangement, regardless of who actually performed the counseling.
Does CPT code 96041 solve the Medicare billing gap?
No. Effective January 2025, 96041 replaced 96040 and lets counselors capture more of their preparatory and follow-up time for billing purposes, but it is a coding change, not a coverage mandate. It helps with commercial and Medicaid payers that already recognize genetic counselors; it does not change Medicare's physician-only billing rule.
Why has this bill failed to pass for nearly a decade?
Primarily an unresolved scope-of-practice disagreement: the American College of Medical Genetics and Genomics has withheld support without language restricting genetic counselors from ordering tests independently, while NSGC argues scope should be governed by state licensure law, not federal reimbursement statute.
What should labs and RCM teams do before the proposed 2027 effective date?
Keep billing Medicare exactly as you do today, confirm CPT 96041 adoption with each of your non-Medicare payers, check your state's own Medicaid and licensure rules for genetic counselors, and track committee activity on S.3607 and H.R.6280 rather than treating introduction of the bill as a signal that passage is likely.