I 
118TH CONGRESS 
1ST SESSION H. R. 3876 
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 6, 2023 
Mr. SMITH of Nebraska (for himself, Mr. HIGGINS of New York, Mr. 
BALDERSON, Ms. SEWELL, Mrs. GONZA´LEZ-COLO´N, Ms. CHU, Mr. 
FLOOD, Ms. CASTOR of Florida, Mr. RASKIN, Mr. FITZPATRICK, Mr. 
SWALWELL, Mr. DUNN of Florida, Mr. AUCHINCLOSS, and Mr. RUTHER-
FORD) 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 juris-
diction 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 2023’’. 
VerDate Sep 11 2014 
03:51 Jul 04, 2023
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3876.IH
H3876
pbinns on DSKJLVW7X2PROD with $$_JOB
SEC. 2. MEDICARE COVERAGE OF GENETIC COUNSELING 
SERVICES. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended— 
(1) in subsection (s)(2)— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (II); 
(B) by adding ‘‘and’’ at the end of sub-
paragraph (JJ); and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(KK) covered genetic counseling services (as 
defined in subsection (nnn)(1));’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘Covered Genetic Counseling Services 
‘‘(nnn)(1) The term ‘covered genetic counseling serv-
ices’ means genetic counseling services furnished by a ge-
netic counselor (as defined in paragraph (2)) (and such 
services and supplies furnished as an incident to the provi-
sion of such services) as would otherwise be covered under 
this title if furnished by a physician (or as incident to a 
physician’s service). 
‘‘(2) The term ‘genetic counselor’ means an indi-
vidual who— 
VerDate Sep 11 2014 
03:51 Jul 04, 2023
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3876.IH
H3876
pbinns on DSKJLVW7X2PROD with $$_JOB
‘‘(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)(KK),’’ 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 (HH)’’ and inserting 
‘‘(HH)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (II) with respect 
to covered genetic counseling services under sec-
tion 1861(s)(2)(KK), furnished by a genetic 
VerDate Sep 11 2014 
03:51 Jul 04, 2023
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3876.IH
H3876
pbinns on DSKJLVW7X2PROD with $$_JOB
counselor, the amount of payment for such 
service shall be an amount equal to 85 percent 
of the lesser of the actual charge for the serv-
ices or the amount determined under the fee 
schedule established under section 1848(b) for 
the same services if furnished by a physician’’. 
(2) MODIFIER.—Section 1834 of the Social Se-
curity Act (42 U.S.C. 1395m) is amended by adding 
at the end the following new subsection: 
‘‘(aa) USE OF MODIFIER WITH RESPECT TO GE-
NETIC COUNSELING SERVICES.— 
‘‘(1) ESTABLISHMENT.—Not later than Janu-
ary 1, 2024, the Secretary shall establish a modifier 
to be utilized with evaluation and management CPT 
codes to indicate (in a form and manner specified by 
the Secretary), in the case of covered genetic coun-
seling services under section 1861(s)(2)(KK), if such 
services were furnished by a genetic counselor. 
‘‘(2) REQUIRED USE.—Each request for pay-
ment, or bill submitted using evaluation and man-
agement CPT codes, for covered genetic counseling 
services (as defined in section 1861(nnn)(1)) fur-
nished by a genetic counselor (as defined in section 
1861(nnn)(2)) on or after January 1, 2024, shall in-
VerDate Sep 11 2014 
03:51 Jul 04, 2023
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3876.IH
H3876
pbinns on DSKJLVW7X2PROD with $$_JOB
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)(KK) and genetic 
counselors (as defined in section 1861(nnn)(2)) in 
the same manner as such provisions apply with re-
spect 
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, 2024. 
(2) 
IMPLEMENTATION.—The 
Secretary 
of 
Health and Human Services may implement the 
VerDate Sep 11 2014 
03:51 Jul 04, 2023
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3876.IH
H3876
pbinns on DSKJLVW7X2PROD with $$_JOB
amendments made by this section by interim final 
rule with comment period. 
Æ 
VerDate Sep 11 2014 
03:51 Jul 04, 2023
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6301
E:\BILLS\H3876.IH
H3876
pbinns on DSKJLVW7X2PROD with $$_JOB