S. 3607 — Access to Genetic Counselor Services Act of 2026

This section establishes Medicare Part B coverage for genetic counseling services (i.e., risk assessment, genetic testing counseling, and related incident-to services) furnished by qualified genetic counselors on or after January 1, 2027, as a new covered physician service under Section 1861(s)(2)(KK) of the Social Security Act (42 U.S.C. 1395x). A genetic counselor is a state-licensed individual or, in states without licensure, one certified by the American Board of Genetic Counseling who meets Secretary criteria. The section (1) prohibits balance billing by genetic counselors; (2) sets payment at 80% of the lesser of the actual charge or 85% of the physician fee schedule amount under Medicare physician fee schedule (Section 1848); (3) makes a conforming amendment to exclude such services from certain therapy cap limitations; and (4) clarifies that the changes do not prevent physicians or other providers from billing separately for otherwise covered genetic counseling. The Secretary may implement by interim final rule with comment period.