MedicaidAdministrativeMedium impact
Licensed Genetic Counselors - Enrollment and Billing as a New Provider Type
Illinois Medicaid - HFS·IL · Genetics·Provider Notice
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now allows licensed genetic counselors to enroll as independent providers and bill directly for genetic counseling services (CPT 96040) effective April 1, 2024. Previously, these services had to be billed under a physician's NPI, but genetic counselors must now enroll separately and transition billing by February 1, 2025.
Action Required
By February 1, 2025: Genetic counselors must enroll in Illinois Medicaid IMPACT system as either Rendering/Servicing Provider or Regular Individual/Sole Proprietor. Obtain NPI if not already obtained. Transition billing of CPT 96040 from physician NPIs to genetic counselor NPIs. After February 1, 2025, physicians providing genetic counseling must use appropriate Evaluation and Management codes instead of 96040.