Trends in coverage and reimbursement for reproductive genetic counseling in New Jersey by multiple payers from 2010 to 2018.
Lack of consistent insurance coverage for genetic counseling services billed under Current Procedural Terminology (CPT) code 96040 creates a barrier for access to this service. This retrospective study examined coverage and reimbursement for reproductive genetic counseling encounters billed under CP...
| Published in: | Journal of Genetic Counseling Vol. 30; no. 6; pp. 1748 - 1757 |
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| Main Authors: | , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Wiley-Blackwell
Dec2021
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=153950802&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 153950802 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10597700 41A jtl: Journal of Genetic Counseling issn: 10597700 maglogo: N pubinfo: dt: Dec2021 vid: 30 iid: 6 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 153950802 151226794 153950802 153950802 10.1002/jgc4.1443 153950802 ppf: 1748 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: Trends in coverage and reimbursement for reproductive genetic counseling in New Jersey by multiple payers from 2010 to 2018. aug: au: Spinosi, Francesca Khan, Shama Seymour, Christine Ashkinadze, Elena affil: Department of Medical Genetics and Genomic Medicine, Saint Peter's University Hospital, New Brunswick NJ,, USA sug: subj: Reproductive Health Genetic Counseling Insurance, Health, Reimbursement Evaluation Insurance Carriers New Jersey Human Retrospective Design Record Review New Jersey Current Procedural Terminology Billing and Claims Fees and Charges Schools, Medical Perinatal Care Licensure Descriptive Statistics Medicare Medicaid Managed Care Programs Comparative Studies Health Services Accessibility Legislation and Jurisprudence United States Prenatal Care ab: Lack of consistent insurance coverage for genetic counseling services billed under Current Procedural Terminology (CPT) code 96040 creates a barrier for access to this service. This retrospective study examined coverage and reimbursement for reproductive genetic counseling encounters billed under CPT code 96040 as a professional fee over an eight‐year period at Rutgers Robert Wood Johnson Medical School, a regional perinatal center in New Jersey, a state requiring licensure. Descriptive statistics were tabulated to assess the disparity between Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers, including how often encounters were covered and if reimbursed, at what percentage of the amount billed. A comparison of individual plan types (Health Maintenance Organization, Point of Service, and Preferred Provider Organization) was carried out. Overall trends in reimbursement were assessed across payers. The study found 61% of 60‐min encounters billed to Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers received coverage. Of all covered 60‐min encounters billed to Managed Care Medicaid and commercial insurance payers, an average of 36% of the amount billed was reimbursed. Medicare/Medicaid encounters were never reimbursed. Commercial insurance covered 65% of encounters billed but this varied between payers. Across all payers, an overall downward trend of reimbursement was demonstrated over the eight‐year period. Lack of consistent service coverage creates a barrier and patients cannot universally access genetic counseling services. Steps to improve coverage need to include passing of legislation, notably the next bill to replace the former H.R. 3235, 'Access to Genetic Counselor Services Act of 2019' and provisions within third‐party payers that allow for credentialing of genetic counseling providers. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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