#319 New CPT Code 96041 Explained: 2025 Billing for Genetic Counselors

With 2025 right around the corner, we are discussing the brand new CPT Code 96041 that will be effective January 1st, 2025. This is a game-changer for the genetic counseling profession, and we have two experts to break it down for us.

Dr. Colleen Campbell is in the last weeks of her NSGC presidency. She also serves as the Director of Genetic Counseling Operations for University of Iowa Health Care. We’re also joined by Brian Reys, a cancer genetic counselor and manager at UT Southwestern’s Cancer Genetics Program. He also serves as a CPT Coding Advisor to NSGC. Colleen and Brian will explain how this new code affects billing and what genetic counselors need to know for 2025!

On This Episode We Discuss:

• Key Differences: Explained the shift from "face-to-face" to "total time" billing between codes.
• Why the Change? Discussed the reasons behind the update and its necessity for the field.

• Total Time Billing: Detailed how this impacts documentation and billing.
• Billable Activities: Highlighted activities now eligible for billing under 96041.

• Expanded Access: Explored how telehealth eligibility broadens access to genetic counseling.

• Best Practices: Provided tips for accurate time documentation.
• The 50% Rule: Explained the significance and implications.

• Payer Reimbursement: Discussed potential hurdles and advocacy strategies.
• Medicare and Medicaid: Analyzed coverage limitations and the path to Medicare recognition.
• State-Specific Medicaid Policies: Emphasized the importance of understanding local regulations.

• Multiple Provider Encounters: Explained how the new code applies in complex scenarios.
• Student Involvement: Discussed billing practices during supervised encounters.
• Institutional Adoption: Provided guidance for clinics and institutions.
• Collaboration: Highlighted the importance of working with billing and compliance departments.

• NSGC's Role: Discussed the organization's efforts to educate stakeholders.
• Individual Advocacy: Encouraged listeners to actively advocate for the new code.

• Real-World Application: Walked through a hypothetical patient interaction to illustrate time documentation and billing.

• GCA Value: Discussed the potential impact of 96041 on GCA roles.
• Independent Provider Status: Explored the potential implications for genetic counselors' recognition.

• Integration into Healthcare: Discussed the role of 96041 in mainstream healthcare.
• Final Advice: Offered concluding advice for genetic counselors and billing departments.

Colleen A. Campbell, PhD, MS, LGC, serves as the 2024 President of the National Society of Genetic Counselors. She also serves as the Director of Genetic Counseling Operations for University of Iowa Health Care where she oversees the administration, standardization and continuous improvement of genetic counseling operations across the health system. In addition, she is a Clinical Associate Professor in the university’s Department of Internal Medicine. Dr. Campbell is an experienced clinician, researcher and educator in clinical genetics, and a recognized leader in the genetic counseling community for her passionate work growing the genetic counseling workforce in underserved areas and advocacy work. She led the successful Iowa legislative effort to license genetic counselors and is actively involved with H.R. 3876/ S.2323 the Access to Genetic Counselor Services Act, to improve patient access to genetic counseling services. Some highlights of her presidential term include leading the development of the 2025-2027 NSGC Strategic Plan, convening the global genetic counseling community in conversations about the global genetic counselor workforce, and leading the development of a four-prong approach to improve reimbursement for genetic counselor services. As a result of her work, she was awarded the 2018 National Society of Genetic Counselors Strategic Leader Award, 2020 Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics Distinguished Alumna Award, and 2024 Saint Mary’s College Distinguished Alumnae Award.

 

Brian Reys, M.S., CGC, joined UT Southwestern Medical Center’s Cancer Genetics Program in 2015. He sees patients at multiple UT Southwestern clinics. He completed his Master of Science degree in medical genetics and genetic counseling at the University of Cincinnati Genetic Counseling Program in 2013.  During his training, he completed a specialized internship in cancer genetics with the Cedars Sinai, GenRISK program in Los Angeles. Prior to moving to Texas, he worked as a genetic counselor in Southern California in the areas of prenatal, pediatric, and cancer genetic counseling. In addition to being a manager with the UT Southwestern Cancer Genetics Program, Reys is a panel member of the National Comprehensive Cancer Network (NCCN) Prostate Cancer Early Detection panel and a CPT Coding Advisor to the National Society of Genetic Counselors (NSGC). He is committed to bridging patient and provider understanding of somatic and germline genetic testing. He has a particular interest in the genetic contribution to prostate, kidney, and bladder cancers. Reys believes that UT Southwestern’s experience in developing leading software in the field of genetic counseling risk assessment is key to increasing the accessibility of genetic counseling and testing for all patients and their families.

 

The National Society of Genetic Counselors (NSGC) created the 2025 Changes to CPT® Billing Code page as a hub for resources relating to the new 96041 code. This includes the recordings for two presentations: one from the annual conference that took place in New Orleans in September, “Goodbye 96040, Hello 9x100: A Genetic Counseling CPT® Code Update for all Genetic Counselors”. And more recently, “CPT Billing Code Updates Webinar: Preparing for 2025” that was live streamed on November 19th, 2024 that was presented by the NSGC Access and Service Delivery (ASD) Committee. There is also a helpful 9 page PDF that answers frequently asked questions (FAQs). These resources require a NSGC membership login.

 

Any additional questions can be submitted to nsgc@nsgc.org with the subject line “CPT/PAYER QUESTION.”

 

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