#319 New CPT Code 96041 Explained: 2025 Billing for Genetic Counselors
DNA Today: A Genetics Podcast
Deep Dive
Why was the new CPT Code 96041 introduced for genetic counselors in 2025?
The new CPT Code 96041 was introduced to address the outdated 'face-to-face' language in the previous code, making it more inclusive of telehealth and recognizing the total time genetic counselors spend on patient care, including preparation and documentation. This change aims to improve billing accuracy and reimbursement for genetic counselors.
What are the key differences between the old CPT Code 96040 and the new CPT Code 96041?
The key differences include the removal of 'face-to-face' language, allowing for total time billing, and the inclusion of non-face-to-face activities such as preparation and documentation. This change better reflects the comprehensive work genetic counselors do and ensures more accurate billing.
How does the new CPT Code 96041 impact documentation and billing for genetic counselors?
The new code requires genetic counselors to document the total time spent on patient care, including preparation, counseling, and follow-up. Institutions are creating standardized language and tools to help counselors accurately report this time, ensuring compliance with billing requirements.
What activities are now eligible for billing under CPT Code 96041?
Activities eligible for billing under CPT Code 96041 include preparation, counseling sessions, documentation, and follow-up communications. This comprehensive approach ensures that all time spent on patient care is reportable.
How does the new CPT Code 96041 broaden access to genetic counseling services?
The new code supports telehealth, making genetic counseling more accessible to patients regardless of their location. It also allows for more accurate billing, which can lead to better reimbursement and more widespread availability of genetic counseling services.
What is the 50% rule, and does it apply to CPT Code 96041?
The 50% rule, which applies to evaluation and management codes, requires that at least half of the time spent on a service must be face-to-face with the patient. However, this rule does not apply to CPT Code 96041, allowing genetic counselors to bill for any combination of preparation, counseling, and documentation time.
What are the potential hurdles in payer reimbursement for CPT Code 96041, and how can they be addressed?
Potential hurdles include payer contracting and credentialing, especially in states without genetic counselor licensure. Genetic counselors can address these by working with their institutions to develop internal processes and by advocating for recognition and credentialing with payers.
How does the new CPT Code 96041 impact billing for genetic counseling assistants (GCAs)?
GCAs are valued as part of the code, but their time is not reported separately. It is assumed that their tasks are part of the standard care process and are included in the total time reported by the genetic counselor.
What is the role of the National Society of Genetic Counselors (NSGC) in educating stakeholders about the new CPT Code 96041?
The NSGC is providing resources and education to help genetic counselors and institutions understand and implement the new code. This includes webinars, presentations, and a dedicated webpage with FAQs and clinical workflow considerations.
What is the significance of the Access to Genetic Counselor Services Act in relation to CPT Code 96041?
The Access to Genetic Counselor Services Act is crucial for getting genetic counselors recognized as independent providers by Medicare. This recognition would improve reimbursement and encourage private insurance companies to follow suit, enhancing access to genetic counseling services.
- New CPT code 96041 effective January 1st, 2025
- Shift from "face-to-face" to "total time" billing
- Includes prep time, patient time, and documentation time
- Telehealth eligible
- Addresses the need for updated billing practices to reflect genetic counselor's activities
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