If you’re considering speaking with a genetic counselor and getting genetic testing, you may be wondering: How much will this cost me? Will my health insurance cover it? These are important questions—and at Genome Medical, we’re here to help you understand what to expect so you can make informed decisions and avoid surprises.
Let’s break down the typical costs, health insurance considerations, and common questions about genetic testing and counseling.
Costs Associated with Genetic Counseling and Genetic Testing
Genetic counseling and genetic testing are two different services, each with their own cost. Here’s what you can expect in terms of costs for each step of the genetic testing process:
1. Initial Visit with a Genetic Counselor (through Genome Medical)
If you are interested in genetic testing, you’ll first meet with a licensed genetic counselor to review your personal and family medical history, discuss whether genetic testing is appropriate for you, and walk through what to expect.
If you already have genetic test results from elsewhere, you can also schedule an appointment with one of our genetic counselors to help you understand the results and determine if additional testing may be helpful.
- Cost of genetic counseling appointment: Up to $250 out-of-pocket without insurance.
- Insurance: May cover some or all of the cost, depending on your plan. Genome Medical is in-network with many major commercial insurers. View a list here. After insurance, most patients pay around $75 for a genetic counseling appointment with Genome Medical. We also offer financial assistance for those who qualify.
2. Genetic Testing through a Commercial Lab
If your genetic counselor recommends testing and you choose to proceed, we will order your genetic test from a genetic testing laboratory. Genome Medical does not perform genetic testing—we submit the order to a lab.
- Cost of genetic testing: Varies widely depending on the test ordered. Genome Medical is unable to provide an estimate for the cost of testing. You will need to contact the lab directly. We can provide you with the contact information for the lab where testing is being recommended, if requested.
- Insurance: Coverage depends on your specific plan, the test ordered, and if it is medically indicated based on published guidelines. Elective genetic testing, without a medical indication, may not be covered.
3. Visit to Review Test Results (through Genome Medical)
Once your genetic test results are ready, you can meet with a Genome Medical genetic counselor to interpret the findings and discuss next steps.
- Cost of genetic counseling appointment: Up to $250 out-of-pocket cost without insurance.
- Insurance: May cover some or all of the cost, depending on your plan. As mentioned above, we are in-network with many major commercial insurers. View a list here.
Do I Need a Genetic Counseling Appointment Before Genetic Testing?
At Genome Medical, we want to ensure that you receive safe, appropriate, and personalized care. That’s why you will need to meet with one of our genetic counselors before we can order genetic testing. Here’s how it works:
If Genome Medical is Ordering Your Genetic Test:
- A genetic counseling appointment is required before a test can be ordered.
- We must see you (virtually) first to review your medical history, determine the most appropriate test, and provide education about what the test can (and cannot) tell you.
- We cannot submit a test order without this appointment—similar to needing a doctor visit to get a prescription or lab test.
Why Genetic Counseling is Important Before Testing
Talking with a genetic counselor before you have genetic testing can help you better understand if genetic testing is necessary based on your medical and family history, what you may learn from the results, and how results can be used by you and your healthcare team to plan your care. Armed with this knowledge, you can make an informed decision on whether genetic testing is right for you and be more prepared for getting your results.
What to Know About Billing
Understanding how billing works can help you plan and feel more confident in your care journey. Here’s what to expect:
- Separate Bills for Separate Services: Think of it like going to a doctor’s appointment and having lab work done. You receive one bill for the doctor visit, and a separate bill from the lab. The same applies here. Genome Medical, a medical practice, bills you (or your insurance) for genetic counseling visits.The lab bills you (or your insurance) separately for the genetic test itself.
- Each Genetic Counseling Visit Has a Separate Cost: If you meet with us twice (once before and once after testing), each session is billed individually.
What Is a Self-Referral?
There are two ways patients may be referred to Genome Medical:
- Provider Referral: Your doctor or healthcare provider may submit a formal referral to us. In this case, you will receive a text and email invitation to schedule your appointment. Using the link in the invitation ensures your visit is correctly scheduled.
- Self-Referral: You can also refer yourself by visiting our website and scheduling an appointment directly—no provider referral is required. This is called a self-referral.
Tip: Some insurance plans require a provider referral for coverage. If you’re self-referring, it’s a good idea to check with your insurance first to confirm coverage.
What About Health Insurance Coverage?
Insurance may cover genetic testing and counseling if it’s deemed medically necessary, such as for diagnosing a suspected genetic disorder or assessing cancer risk. Coverage varies by provider and plan. While Genome Medical is in-network with many major commercial insurers, each plan is different.
Key Points to Remember:
- Genetic counseling and genetic testing are billed separately and may be covered differently.
- Coverage varies by plan—even within the same insurance company.
- Some plans require a provider referral or prior authorization. If you self-refer and your plan requires a referral, the appointment may not be covered.
- Your insurance provider may require a genetic counseling visit before testing, in order for genetic testing to be covered.
At this time, Genome Medical does not accept government-affiliated insurance providers including Medicaid, Medicare and/or Tricare as a primary or secondary insurance (including Managed Medicare and Medicaid plans) for genetic counseling services.
Questions to Ask Your Insurance Provider
To help you get the clearest picture of your potential costs, we recommend calling your insurance provider before your appointment to see if your plan covers genetic counseling and genetic testing. Here are helpful questions to ask:
About Genetic Counseling Coverage
- Does my plan cover genetic counseling? These are the reimbursement codes your insurance provider may need to provide that answer: CPT 96041 and S0265.
- Is Genome Medical in-network for my plan? This is Genome Medical’s NPI number: 1407389695, that you may be asked for by your insurance provider.
- Do I need a provider referral for genetic counseling to be covered?
- What are my out-of-pocket costs, such as co-pays or deductibles, for a genetic counseling appointment?
About Genetic Testing Coverage
- Does my plan cover the specific genetic test being recommended? In order to determine coverage your insurance company may need the reimbursement CPT code for the test and ICD-10 code for the indication. The lab can provide this information to you.
- Is prior authorization required for genetic testing?
- What are my out-of-pocket costs, such as co-pays or deductibles, for genetic testing?
Clarifying Common Questions
We often hear similar questions from patients, and we’re glad to provide helpful explanations to support your decision-making:
“I thought genetic counseling was free.”
In some situations, genetic counseling or testing may be offered at reduced or no cost through hospital programs, advocacy organizations, or laboratories for eligible patients. However, these services are limited to specific programs. Outside of these programs, genetic counseling services involve a charge.
“I didn’t realize I’d receive two bills.”
Because testing and counseling are provided by different organizations, you will receive one bill from Genome Medical (for each genetic counseling visit) and one from the lab (for testing), similar to most medical care settings.
“You’re in-network with my insurance plan, so the appointment should be covered, right?”
While Genome Medical may be in-network with your insurance, coverage depends on your specific plan. There may still be out-of-pocket costs such as deductibles or co-pays. Also, some plans require a provider referral—if you self-refer and a referral is required, your visit may not be covered. We recommend confirming coverage with your insurance in advance.
“Do you accept Medicare or Medicaid?”
At this time, Genome Medical does not accept Medicare or Medicaid for genetic counseling services. However, we are committed to making care accessible. If cost is a concern, we encourage you to explore our Financial Assistance Program.
Ready to Take the Next Step?
We hope this information helps you feel more confident in planning for genetic counseling and testing. By understanding how the process works—and what costs to expect—you can make the decisions that are right for you and your family. We’re honored to be a part of your care journey.
To schedule a self-referral appointment, visit our Patients & Families page.
