Forum - Questions & Answers

Mar 15th, 2018 - sharris

Genetic BRCA Counseling

I would like to get opinion as to whether Genetic Counseling is considered part of the global surgical package.

If a patient has a procedure and the provider provides genetic counseling is this separately billable from the surgery?

Mar 21st, 2018 - ChrisW   256  1 

re: Genetic BRCA Counseling

The Genetic counseling codes all have a status indicator of "B".
Status indicators are assigned to procedures by CMS to indicate whether the code is covered or paid separately. Status indicator ‘B’ describes a “bundled code”, indicating reimbursement for this service is always included in the reimbursement for another service. While these are CMS' guidelines many other payers follow the same rules. In addition, it would be inappropriate to use Modifier -59 to over-ride code edits.

Per CMS:
B = Payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amounts for these codes and no separate payment is ever made. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident (an
example is a telephone call from a hospital nurse regarding care of a patient).

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