New CPT Code 96041 Explained: 2025 Billing for Genetic Counselors

With 2025 right around the corner, we are discussing the brand new CPT Code 96041 that will be effective January 1st, 2025. This is a game-changer for the genetic counseling profession, and we have two experts to break it down for us.

Dr. Colleen Campbell is in the last weeks of her NSGC presidency. She also serves as the Director of Genetic Counseling Operations for University of Iowa Health Care. We’re also joined by Brian Reys, a cancer genetic counselor and manager at UT Southwestern’s Cancer Genetics Program. He also serves as a CPT Coding Advisor to NSGC. Colleen and Brian will explain how this new code affects billing and what genetic counselors need to know for 2025!

On This Episode We Discuss:
Key Differences: Explained the shift from "face-to-face" to "total time" billing between codes.
Why the Change? Discussed the reasons behind the update and its necessity for the field.
Total Time Billing: Detailed how this impacts documentation and billing.
Billable Activities: Highlighted activities now eligible for billing under 96041.
Expanded Access: Explored how telehealth eligibility broadens access to genetic counseling.
Best Practices: Provided tips for accurate time documentation.
The 50% Rule: Explained the significance and implications.
Payer Reimbursement: Discussed potential hurdles and advocacy strategies.
Medicare and Medicaid: Analyzed coverage limitations and the path to Medicare recognition.
State-Specific Medicaid Policies: Emphasized the importance of understanding local regulations.
Multiple Provider Encounters: Explained how the new code applies in complex scenarios.
Student Involvement: Discussed billing practices during supervised encounters.
Institutional Adoption: Provided guidance for clinics and institutions.
Collaboration: Highlighted the importance of working with billing and compliance departments.
NSGC's Role: Discussed the organization's efforts to educate stakeholders.
Individual Advocacy: Encouraged listeners to actively advocate for the new code.
Real-World Application: Walked through a hypothetical patient interaction to illustrate time documentation and billing.
GCA Value: Discussed the potential impact of 96041 on GCA roles.
Independent Provider Status: Explored the potential implications for genetic counselors' recognition.
Integration into Healthcare: Discussed the role of 96041 in mainstream healthcare.
Final Advice: Offered concluding advice for genetic counselors and billing departments.

The National Society of Genetic Counselors (NSGC) created the 2025 Changes to CPT® Billing Code page as a hub for resources relating to the new 96041 code. This includes the recordings for two presentations: one from the annual conference that took place in New Orleans in September, “Goodbye 96040, Hello 9x100: A Genetic Counseling CPT® Code Update for all Genetic Counselors”. And more recently, “CPT Billing Code Updates Webinar: Preparing for 2025” that was live streamed on November 19th, 2024 that was presented by the NSGC Access and Service Delivery (ASD) Committee. There is also a helpful 9 page PDF that answers frequently asked questions (FAQs). These resources require a NSGC membership login.

Any additional questions can be submitted to [email protected] with the subject line “CPT/PAYER QUESTION.”

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