I 

116TH CONGRESS 

1ST SESSION H. R. 3235 

To amend title XVIII of the Social Security Act to provide for expanded 

coverage of services furnished by genetic counselors under part B of 

the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 12, 2019 

Mr. LOEBSACK (for himself and Mr. KELLY of Pennsylvania) introduced the 

following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for expanded coverage of services furnished by genetic 

counselors under part B of the Medicare program, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Access to Genetic 

5 Counselor Services Act of 2019’’. 


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1 SEC. 2. MEDICARE COVERAGE OF GENETIC COUNSELING 

2 SERVICES. 

3 (a) IN GENERAL.—Section 1861 of the Social Secu4 rity Act (42 U.S.C. 1395x) is amended— 

5 (1) in subsection (s)(2)— 

6 (A) by striking ‘‘and’’ at the end of sub7 paragraph (GG); 

8 (B) by adding ‘‘and’’ at the end of sub9 paragraph (HH); and 

10 (C) by adding at the end the following new 

11 subparagraph: 

12 ‘‘(II) covered genetic counseling services (as de13 fined in subsection (kkk)(1));’’; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘Covered Genetic Counseling Services 

17 ‘‘(kkk)(1) The term ‘covered genetic counseling serv18 ices’ means genetic counseling services furnished by a ge19 netic counselor (as defined in paragraph (2)) (and such 

20 services and supplies furnished as an incident to the provi21 sion of such services) as would otherwise be covered under 

22 this title if furnished by a physician (or as incident to a 

23 physician’s service). 

24 ‘‘(2) The term ‘genetic counselor’ means an indi25 vidual who— 


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1 ‘‘(A) is licensed as a genetic counselor by the 

2 State in which the individual furnishes genetic coun3 seling services; or 

4 ‘‘(B) in the case of an individual practicing in 

5 a State that does not license genetic counselors, 

6 meets such other criteria as the Secretary estab7 lishes. 

8 The provisions of this paragraph shall not be construed 

9 as preventing other practitioners, including those pro10 viding telehealth services, from providing covered genetic 

11 counseling services within the scope of their practice.’’. 

12 (b) PHYSICIANS’ SERVICES.—Section 1848(j)(3) of 

13 the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 

14 amended by inserting ‘‘(2)(II),’’ after ‘‘(2)(FF) (including 

15 administration of the health risk assessment) ,’’. 

16 (c) PAYMENT.— 

17 (1) IN GENERAL.—Section 1833(a)(1) of the 

18 Social Security Act (42 U.S.C. 1395l(a)(1)) is 

19 amended— 

20 (A) by striking ‘‘and (CC)’’ and inserting 

21 ‘‘(CC)’’; and 

22 (B) by inserting before the semicolon at 

23 the end the following: ‘‘, and (DD) with respect 

24 to covered genetic counseling services under sec25 tion 1861(s)(2)(II), furnished by a genetic 


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1 counselor, the amount of payment for such 

2 service shall be an amount equal to 85 percent 

3 of the lesser of the actual charge for the serv4 ices or the amount determined under the fee 

5 schedule established under section 1848(b) for 

6 the same services if furnished by a physician’’. 

7 (2) MODIFIER.—Section 1834 of the Social Se8 curity Act (42 U.S.C. 1395m) is amended by adding 

9 at the end the following new subsection: 

10 ‘‘(x) USE OF MODIFIER WITH RESPECT TO GENETIC

11 COUNSELING SERVICES.— 

12 ‘‘(1) ESTABLISHMENT.—Not later than Janu13 ary 1, 2020, the Secretary shall establish a modifier 

14 to be utilized with evaluation and management CPT 

15 codes to indicate (in a form and manner specified by 

16 the Secretary), in the case of covered genetic coun17 seling services under section 1861(s)(2)(II), if such 

18 services were furnished by a genetic counselor. 

19 ‘‘(2) REQUIRED USE.—Each request for pay20 ment, or bill submitted using evaluation and man21 agement CPT codes, for covered genetic counseling 

22 services (as defined in section 1861(kkk)(1)) fur23 nished by a genetic counselor (as defined in section 

24 1861(kkk)(2)) on or after January 1, 2020, shall inVerDate Sep 11 2014 23:20 Jun 17, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3235.IH H3235

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1 clude the modifier established under subparagraph 

2 (A) for each such service.’’. 

3 (d) ASSIGNMENT OF PAYMENT.—Section 1833(r) of 

4 the Social Security Act (42 U.S.C. 1395l(r)) is amended 

5 by adding at the end the following new paragraph: 

6 ‘‘(3) APPLICATION TO GENETIC COUNSELORS.— 

7 The provisions of paragraphs (1) and (2) shall apply 

8 with respect to covered genetic counseling services 

9 described in section 1861(s)(2)(II) and genetic coun10 selors (as defined in section 1861(kkk)(2)) in the 

11 same manner as such provisions apply with respect 

12 to services described in section 1861(s)(2)(K)(ii) and 

13 nurse practitioners.’’. 

14 (e) CONFORMING AMENDMENT.—Section 

15 1862(a)(14) of the Social Security Act (42 U.S.C. 

16 1395(y)(a)(14)) is amended by inserting ‘‘covered genetic 

17 counseling services,’’ after ‘‘qualified psychologist serv18 ices,’’. 

19 (f) EFFECTIVE DATE.— 

20 (1) IN GENERAL.—The amendments made by 

21 this section shall apply to services furnished on or 

22 after January 1, 2020. 

23 (2) IMPLEMENTATION.—The Secretary of 

24 Health and Human Services may implement the 


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1 amendments made by this section by interim final 

2 rule with comment period. 

Æ 


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