2025 HCPCS code S0265
(Deleted/Inactive (as of 04/01/2024, per ProMedica policy.Medicare does not pay for this code.)) Effective Date: N/A Revision Date: N/A Deletion Date: Apr 1, 2024 Provider Services - Genetic Counseling Miscellaneous Provider Services Feed
Genetic counseling, under physician supervision, for each 15-minute interval.
Modifiers may be applicable depending on the specific circumstances, payer requirements, and the services rendered. Consult payer guidelines for permissible modifiers.
Genetic counseling is medically necessary when a patient faces a significant risk of a genetic disorder or has received abnormal genetic test results.Justification should be provided in the medical record, indicating the clinical rationale for the counseling.
The physician is responsible for supervising the genetic counselor during the counseling sessions. The genetic counselor conducts the assessment and counseling, but the physician must oversee the process.
In simple words: This code is for a doctor's supervision of a counselor talking to a patient and/or their family about genetic diseases or risks. The counselor helps them understand genetic test results and discusses how to manage the situation.The code is used for every 15 minutes of this counseling session.
This HCPCS code represents genetic counseling services performed under the direct supervision of a physician.The code is reported for each 15-minute unit of counseling time dedicated to assessing genetic diseases or disorders, advising on associated risks, reviewing family and personal medical history, and counseling the patient about findings, management options, and familial genetic risks.The provider's role includes reviewing medical records and interviewing family members.
Example 1: A patient receives a positive result from a genetic test indicating an increased risk of breast cancer. A genetic counselor, under physician supervision, spends 45 minutes (3 units of S0265) counseling the patient and their family about the risks, management options (e.g., increased screening, prophylactic surgery), and implications for future generations., A couple undergoing pre-conception genetic counseling meets with a genetic counselor (under the supervision of a physician) for 30 minutes (2 units of S0265) to discuss family history and carrier screening results. The counselor assists them in understanding their options and making informed reproductive decisions., A patient who has a child with a rare genetic disorder requires counseling regarding recurrence risks for future pregnancies. This requires a 60-minute consultation (4 units of S0265) with a genetic counselor under a physician's supervision to discuss the diagnosis, management, and the risk of recurrence.
Detailed documentation of the counseling session is crucial. This should include:the patient's medical history (including family history), the reason for the genetic counseling, the genetic test results (if applicable), a summary of the information provided to the patient and family, and the patient's understanding of the information. Documentation must clearly indicate the physician's supervision.Time spent should be accurately documented for each 15-minute interval.
** This code is largely obsolete due to its removal from many payer policies.Always verify payer coverage and coding guidelines before submitting claims using this code.Consider using alternative CPT codes for genetic counseling services where appropriate. The code's future use is uncertain due to the lack of updates from CMS.
- RVU: Not applicable.This is an HCPCS code and is not assigned RVUs in the same way as CPT codes.
- Global Days: Not applicable. This code represents time-based counseling services, not a procedure with a global period.
- Payment Status: Inactive for many payers, including Medicare. Payment varies among private payers.
- Modifier TC rule: Not applicable. This code does not have a technical component.
- Fee Schedule: Historically, reimbursement for S0265 varied widely among payers.Medicare did not cover it. Since it's now considered inactive by some payers, fee schedule information is less relevant.
- Specialties:Medical Genetics, Genetic Counseling, Oncology, Obstetrics/Gynecology
- Place of Service:Office, Hospital (Outpatient), Clinic