Billing & Insurance

Will my insurance cover genetic counseling?

Many insurances cover genetic counseling services, including those provided by telehealth, but coverage varies by state and by insurance plan. Insurances may only cover genetic counseling visits for certain indications, may not cover telehealth genetic counseling, or may not cover genetic counseling services at all. Please check your individual insurance plan.

Prior authorization may be required. It is your responsibility to know and understand the benefits and coverage of your insurance plan. If you would like to contact your insurance to find out if they cover genetic counseling services, they may ask for a procedure (or CPT) code for the visit. The code GSF bills for genetic counseling visits is 96041.

As a courtesy, GSF will bill your insurance carrier on your behalf, but it is important to understand that you are ultimately responsible for the payment of your bill. You are responsible for any co-pays, co-insurance, deductibles, and all other procedures not covered by your insurance plan. If you are requesting that GSF bill your insurance, your insurance information will be collected when you schedule your appointment. You may also choose to pay for the genetic counseling visit and then submit the claim to your insurance company yourself for reimbursement.

Whether GSF is in-network or out-of-network may determine whether insurance will cover the visit. GSF is currently in network with the following insurances:

  • Aetna
  • Amerigroup of Washington
  • Community Health Plan of Washington
  • First Choice Health
  • Kaiser Foundation Health Plan of Washington Options, Inc
  • Molina Healthcare of Washington
  • Premera Blue Cross
  • Regence BlueShield
  • Community Health Plan of Washington

We cannot guarantee coverage by your insurance. Any questions or complaints regarding coverage should be directed to your insurance carrier.

How much does an appointment cost if insurance does not cover it or if I choose to pay out-of-pocket?

Our fees for genetic counseling are based on the total time of the visit. The total time includes the time meeting with the genetic counselor, and time spent preparing for your specific visit and follow-up activities including coordinating test orders and documentation.  Per the American Medical Association, time per unit for genetic counseling is as follows:  

  • Tier 1: $125 (16-45 minutes total time)
  • Tier 2: $250 (46-75 minutes total time)
  • Tier 3: $375 (76-105 minutes total time)
  • Tier 4: $500 (106-135 minutes total time) 

Prompt Pay Discount: 

We offer a 20% for patients paying for the visit directly. This discount must be determined prior to the date of service. The discounted costs are:

  • Tier 1: $100 (16-45 minutes total time)
  • Tier 2: $200 (46-75 minutes total time)
  • Tier 3: $300 (76-105 minutes total time)
  • Tier 4: $400 (106-135 minutes total time) 

Patients choosing the prompt pay discount must submit a $200 deposit before the visit. If the visit costs less than $200, the difference will be refunded. If the visit costs more than $200, the additional amount will be billed to the patient.  

 

Does GSF have a financial assistance program?

It is both the philosophy and practice of GSF that genetic services, including genetic counseling, should be available to those in need, regardless of their ability to pay. Financial assistance is available secondary to all other financial resources available, including but not limited to insurance, third party liability payors, government programs, and outside agency programs.

Eligibility for financial assistance shall be based on financial need at the time of the application, and is based on the Federal Poverty Guidelines. Households with incomes less than 400% of the Federal Poverty Level qualify for genetic counseling at zero cost. For 2025:

Household size If your household income is less than or equal to this, you qualify for a free genetic counseling visit
1 $62,600
2 $84,600
3 $106,600
4 $128,600
5 $150,600
6 $172,600
7 $194,600
8 $216,600
*For households with more than 8 persons, add $22,000 for each additional person

 

Supporting income documentation may be required with this application to be eligible for this program. Supporting documentation must be in the form of an IRS Form 1040. If an IRS Form 1040 is not available, submit a brief letter explaining your income source and why an IRS Form 1040 is not available. Additional documentation such as W-2 statements, copies of recent paychecks, and/or bank statements showing activity may be included as well.

Applications for financial assistance can be filled out on our website as you are scheduling your appointment.  Click here to complete a financial assistance application online.

If you have more questions, or need to speak to a representative, please contact us at (844) 743-6384.

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