A landscape assessment of Medicaid recognition for genetic counselors.
Payer enrollment for genetic counselors (GCs) is fundamental to long‐term field sustainability and patient care access. Until federal recognition is obtained, enhancing Medicaid policies may help address existing GC coverage disparities. Understanding the current landscape is critical to mapping an...
| Publicado en: | Journal of Genetic Counseling Vol. 34; no. 3; pp. 1 - 12 |
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| Autores principales: | , , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Jun2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=186226469&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 186226469 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10597700 41A jtl: Journal of Genetic Counseling issn: 10597700 maglogo: N pubinfo: dt: Jun2025 vid: 34 iid: 3 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 186226469 186226469 186226469 10.1002/jgc4.70057 186226469 ppf: 1 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: C – @attributes: type: P tig: atl: A landscape assessment of Medicaid recognition for genetic counselors. aug: au: Reys, Brian Valentine, Alyssa Pan, Vivian Gaston, Delaney Harper, Mardarius Brouette, Maya Nuccio, Regina affil: Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas Texas,, USA sug: subj: Medicaid United States Genetic Counselors Genetic Counseling Licensure Health Policy Billing and Claims Fees and Charges Reimbursement Mechanisms Human United States Cross Sectional Studies Descriptive Research Coding Public Health Medically Underserved Current Procedural Terminology Maps Health Services Accessibility Evaluation ab: Payer enrollment for genetic counselors (GCs) is fundamental to long‐term field sustainability and patient care access. Until federal recognition is obtained, enhancing Medicaid policies may help address existing GC coverage disparities. Understanding the current landscape is critical to mapping an effective strategy for future advocacy efforts. This study assessed GC provider enrollment and relevant CPT® codes across Medicaid programs in the United States via a review of open‐access Medicaid websites for 50 US states, Washington, DC, and 5 US territories in 2024. Medicaid fee status for CPT® code 96040 (GC only, 30 min) and S0265 (GC with physician supervision, 15 min code), fee schedule dates, availability of GC as a provider enrollment type, and state licensure status were abstracted. Of Medicaid provider enrollment websites for US states and DC, 21.6% (11/51) included genetic counselors; 49% (25/51) listed CPT® code 96040 and 13.7% (7/51) listed S0265 in the fee schedule with a non‐zero rate; none of the US territories listed either. Of the 34 regions with GC licensure, 32.4% (11/34) included GCs as an enrollment type in their state Medicaid provider website, while none of the 22 unlicensed regions did. This assessment highlights a gap between state licensure efforts and enrollment of GCs by state payers. Advocacy and public health policy directly targeting state Medicaid programs provide another avenue to increase coverage for GC services. A key downstream benefit of GC recognition through these efforts includes expanding access to genetic counseling services for underserved communities. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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