I 
115TH CONGRESS 
2D SESSION 
H. R. 7083 
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 
OCTOBER 23, 2018 
Mr. PAULSEN (for himself and Mr. LOEBSACK) 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 subse-
quently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Access to Genetic 
Counselor Services Act of 2018’’. 
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SEC. 2. MEDICARE COVERAGE OF GENETIC COUNSELING 
SERVICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (FF); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (GG); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(HH) covered genetic counseling services (as 
defined in subsection (jjj)(1));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Covered Genetic Counseling Services 
‘‘(jjj)(1) The term ‘covered genetic counseling serv-
ices’ means genetic counseling services furnished by a ge-
netic counselor (as defined in paragraph (2)) (and such 
services and supplies furnished as an incident to the provi-
sion of such services) as would otherwise be covered under 
this title if furnished by a physician (or as incident to a 
physician’s service). 
‘‘(2) The term ‘genetic counselor’ means an indi-
vidual who— 
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‘‘(A) is licensed as a genetic counselor by the 
State in which the individual furnishes genetic coun-
seling services; or 
‘‘(B) in the case of an individual practicing in 
a State that does not license genetic counselors, 
meets such other criteria as the Secretary estab-
lishes. 
The provisions of this paragraph shall not be construed 
as preventing other practitioners, including those pro-
viding telehealth services, from providing covered genetic 
counseling services within the scope of their practice.’’. 
(b) PHYSICIANS’ SERVICES.—Section 1848(j)(3) of 
the Social Security Act (42 U.S.C. 1395w–4(j)(3)) is 
amended by inserting ‘‘(2)(HH),’’ after ‘‘(2)(FF) (includ-
ing administration of the health risk assessment) ,’’. 
(c) PAYMENT.— 
(1) IN GENERAL.—Section 1833(a)(1) of the 
Social Security Act (42 U.S.C. 1395l(a)(1)) is 
amended— 
(A) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (CC) with respect 
to covered genetic counseling services under sec-
tion 1861(s)(2)(HH), furnished by a genetic 
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counselor, the amount of payment for such 
service shall be an amount equal to 85 percent 
of the lesser of the actual charge for the serv-
ices or the amount determined under the fee 
schedule established under section 1848(b) for 
the same services if furnished by a physician’’. 
(2) MODIFIER.—Section 1834 of the Social Se-
curity Act (42 U.S.C. 1395m) is amended by adding 
at the end the following new subsection: 
‘‘(w) USE OF MODIFIER WITH RESPECT TO GENETIC 
COUNSELING SERVICES.— 
‘‘(1) ESTABLISHMENT.—Not later than Janu-
ary 1, 2019, the Secretary shall establish a modifier 
to be utilized with evaluation and management CPT 
codes to indicate (in a form and manner specified by 
the Secretary), in the case of covered genetic coun-
seling services under section 1861(s)(2)(HH), if 
such services were furnished by a genetic counselor. 
‘‘(2) REQUIRED USE.—Each request for pay-
ment, or bill submitted using evaluation and man-
agement CPT codes, for covered genetic counseling 
services (as defined in section 1861(jjj)(1)) fur-
nished by a genetic counselor (as defined in section 
1861(jjj)(2)) on or after January 1, 2019, shall in-
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clude the modifier established under subparagraph 
(A) for each such service.’’. 
(d) ASSIGNMENT OF PAYMENT.—Section 1833(r) of 
the Social Security Act (42 U.S.C. 1395l(r)) is amended 
by adding at the end the following new paragraph: 
‘‘(3) APPLICATION TO GENETIC COUNSELORS.— 
The provisions of paragraphs (1) and (2) shall apply 
with respect to covered genetic counseling services 
described in section 1861(s)(2)(HH) and genetic 
counselors (as defined in section 1861(jjj)(2)) in the 
same manner as such provisions apply with respect 
to services described in section 1861(s)(2)(K)(ii) and 
nurse practitioners.’’. 
(e) 
CONFORMING
AMENDMENT.—Section 
1862(a)(14) of the Social Security Act (42 U.S.C. 
1395(y)(a)(14)) is amended by inserting ‘‘covered genetic 
counseling services,’’ after ‘‘qualified psychologist serv-
ices,’’. 
(f) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply to services furnished on or 
after January 1, 2019. 
(2) 
IMPLEMENTATION.—The 
Secretary 
of 
Health and Human Services may implement the 
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amendments made by this section by interim final 
rule with comment period. 
Æ 
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