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22.3 Benefits and Limitations
Genetic services providers are reimbursed for the provision of genetic services to evaluate clients for the possibility of a genetic disorder, diagnose such disorders, counsel clients regarding such disorders and their implications for family planning, and provide follow-up of clients with known or suspected disorders.
Genetic services encompass the professional component (examination, diagnosis, consultation, counseling, and follow-up). For all providers, documentation in the medical record must support the level of physician evaluation and management procedure code used.
Providers of genetic services are not limited to geneticists. Physicians (MD, DO) and advanced practice nurses can order genetic laboratory tests and/or provide professional services related to genetic disease management for patients. To provide Medicaid services, each nurse practitioner (NP) or clinical nurse specialist (CNS) must be licensed as a registered nurse and recognized as an advanced practice nurse (APN) by the Texas Board of Nursing (BON).
Genetic services are payable when provided in the office setting (place of service [POS 1]), in the inpatient hospital setting (POS 3), and in the outpatient hospital setting (POS 5).
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