Abstract
Reimbursement for genetic counseling services was examined at a single institution. Patient encounters utilizing the 96040 CPT® code from 7/31/2009 through 7/31/2013 were reviewed. Exclusion criteria included billing records of patients seen by a physician the same day, self-pay, Medicaid, and Medicare patients. Of the 8,630 encounters with a genetic counselor, 582 encounters were eligible for review. Descriptive statistics (i.e., percentage of encounters receiving some level of reimbursement, average reimbursement rate, number of third party payors providing any level of reimbursement, and number of ICD-9 codes receiving any level of reimbursement) depicted reimbursement of the 96040 CPT® code for the encounters analyzed. Statistical analysis found a significant difference in reimbursement between third party payors that do and do not credential genetic counselors (p < .0001). There was no statistically significant difference between reimbursement rates for primary diagnostic ICD-9 codes when compared to primary diagnostic ICD-9 V codes used. Results will provide a useful baseline for local and national comparisons due to the paucity of data regarding CPT® 96040.
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This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required. It was reviewed by the appropriate institutional ethics committee at Sanford Health and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Leonhard, J.R., Munson, P.J., Flanagan, J.D. et al. Analysis of Reimbursement of Genetic Counseling Services at a Single Institution in a State Requiring Licensure. J Genet Counsel 26, 852–858 (2017). https://doi.org/10.1007/s10897-016-0062-7
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DOI: https://doi.org/10.1007/s10897-016-0062-7