HB6280, the Access to Genetic Counselor Services Act of 2025, would amend the Social Security Act to add “covered genetic counseling services” to Medicare Part B. The bill defines those services as genetic counseling furnished on or after January 1, 2027, by a qualified genetic counselor, including related supplies and incident services that the counselor is legally authorized to provide under state law. It also defines who qualifies as a genetic counselor for Medicare purposes: generally, a state-licensed genetic counselor, or, in states without licensure, a counselor certified by the American Board of Genetic Counseling who meets additional criteria set by the Secretary of Health and Human Services.
The bill would require Medicare to pay for these services at 80 percent of the lesser of the actual charge or 85 percent of the physician fee schedule amount that would have applied if a physician had furnished the service. It also makes a conforming change to Medicare’s payment and coverage rules and clarifies that the new provisions do not prevent physicians or other providers from billing for genetic counseling services that are otherwise covered under existing Medicare rules. The Secretary of Health and Human Services would be authorized to implement the changes through an interim final rule with comment period.
If enacted, the bill would expand Medicare coverage and reimbursement to a broader set of genetic counseling services, creating a new statutory category under title XVIII of the Social Security Act. It would affect Medicare beneficiaries who need genetic counseling, genetic counselors as a provider class, and Medicare administrative and payment systems. Because the bill ties coverage to state licensure or certification, it also interacts with state professional regulation of genetic counselors.
The available context shows generally positive or at least supportive intent, with bipartisan sponsorship by Representatives Smith of Nebraska and Castor of Florida. There is no recorded committee debate or vote history in the provided materials, so there is no evidence of formal opposition in the record here. The bill appears focused on access and reimbursement rather than restricting existing provider billing, which may reduce controversy, though the use of Medicare payment rules and the reliance on state licensure standards could raise implementation questions.
Notable points of contention, if any arise, would likely center on Medicare spending, the scope of services eligible for coverage, and how genetic counselors are recognized in states without licensure. Another possible issue is whether the payment rate—based on 85 percent of the physician fee schedule—adequately reflects the value of the service. The bill’s text, however, explicitly preserves billing by physicians and other providers for otherwise covered genetic counseling services, suggesting an effort to avoid displacement of existing providers.
HB6280 would amend sections 1861, 1833, 1842, and 1862 of the Social Security Act to create a new Medicare Part B covered service category for genetic counseling. It would establish federal payment rules for those services, define eligible practitioners, and align Medicare’s balance-billing and coverage provisions accordingly. The bill would not preempt state licensure regimes, but instead uses them as the primary qualification standard for providers.
The bill appears to have a favorable and access-oriented posture, with bipartisan introduction and no recorded opposition, votes, or committee objections in the provided materials. The sponsors’ framing suggests support for expanding beneficiary access to genetic counseling and recognizing the role of genetic counselors within Medicare.
No formal contention is documented in the provided record, but the most likely issues would be Medicare cost implications, the appropriate reimbursement methodology, and provider-qualification standards in states that do not license genetic counselors. Some stakeholders could also question whether the bill expands coverage too broadly or whether it sufficiently protects existing physician and provider billing arrangements; the bill addresses the latter by expressly preserving current billing rights for other providers.