CSHCN 2008 > Physician > Benefits and Limitations

24.3.14 Genetics

Geneticists provide services to evaluate clients for the possibility of a genetic disorder, diagnose such disorders, counsel clients/families regarding such disorders, and provide follow-up care to clients with known or suspected disorders.

Genetic services provided by geneticists are benefits of the CSHCN Services Program, and include the professional component (consultative counseling and follow-up) and laboratory testing. Laboratory and radiology services are not reimbursed to providers using a genetic services provider identifier, but may be reimbursed with an appropriate CSHCN Services Program provider identifier.

The following procedure codes may be reimbursed for geneticists when provided in the office, inpatient hospital, or outpatient hospital setting:

Office consultation, procedure codes G-99244, G-99245, and G-99404 are limited to once every three years.

Inpatient consultations, procedure codes G-99254 and G-99255, may be reimbursed once every three years regardless if an office consultation was reimbursed in the previous three years.

A comprehensive follow up visit, procedure code G-99215, is limited to once per year. No authorization is required for genetic services that are a benefit of the CSHCN Services Program.

Refer to: Section 19.4.6, "Cytogenetics Testing," on page 19-6 for more information on cytogenetic testing.