Posted in BCBS (Various States), Training, Updates

BCBS Michigan: Genetic Counselors to receive direct payment 01/01/2022

What genetic counselors do?
Genetic counselors obtain and evaluate individual, family and medical histories to determine the risk for genetic or medical conditions or diseases in a member, the member’s descendants or other family members.
Genetic counselors explain to the member the clinical implications of genetic laboratory tests and other diagnostic studies and their results.

According to BCBS of Michigan genetic counselors have an opportunity to participate in BCBS of Michigan’s Traditional and TRUST PPO networks, and BCN commercial, effective Jan. 1, 2022.

This change, effective for outpatient services provided on or after Jan. 1, applies to Blue Cross and BCN benefit plans that cover services that these providers are licensed to provide.


How to Enroll?

Genetic counselors can find enrollment forms and practitioner agreements on bcbsm.com/providers. To find enrollment information, click on Enroll to become a provider. Specific qualification requirements are identified within each agreement. All applicants must pass a credentialing review before participation. BCBS of Michigan will notify applicants in writing of their approval status.


Checking Member Benefits:

To find out if a member has coverage, check web-DENIS for member benefits and eligibility or call Provider Inquiry at 1-800-344-8525

Medical Billing:

Participating Genetic Counselors are allowed to directly bill codes to BCBS of Michigan:

*96040 and S0265, under professional services.

Reimbursement Rate:

Directly billed codes will be reimbursed at 85% of the applicable fee schedule, minus any member deductibles and copayments.

Prior Authorization Requirements:

Genetic Counseling does not require an authorization. For BCN commercial members who have a primary care physician that is part of a medical care group based in the East or Southeast region, their primary care provider must submit a referral for a specialist office visit. Referrals are not required for other members.

To learn more about BCBS of Michigan Genetic Testing and Counseling, please click here to read the full policy.


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