CPT 96040: Medical Genetics and Genetic Counseling, 30 Min
Commercial payers pay $99 on average nationally for this procedure.
CPT code 96040 describes medical genetics and genetic counseling services provided in 30‑minute, face‑to‑face sessions with a patient and/or family and is used to bill for structured genetic counseling encounters that include risk assessment, review of genetic testing options, and interpretation of results; the service type is genetic counseling and the typical site of service is an outpatient clinic or ambulatory genetics practice where the counselor meets directly with the patient or family for a focused half‑hour encounter.
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National Reimbursement Benchmarks
Across commercial payers, BUCA sits near the mid-to-high range with an average commercial rate of $99.4, offering a useful benchmark for market-level expectations. Blue Cross Blue Shield averages $76.8 and Cigna is notably higher at $148.4, while UnitedHealth Group averages $95.7. These averages highlight a multifold spread between lower-average and higher-average payers, with Cigna pulling the overall ceiling of mean rates upward.
Dispersion (P75 minus P25) highlights how tightly rates cluster: Blue Cross Blue Shield’s dispersion is $32.0 ($88.5 - $57.1), BUCA’s is $50.1 ($117.9 - $69.8), Cigna’s is $76.9 ($186.7 - $109.8), and UnitedHealth Group’s is $52.0 ($107.9 - $55.3). Cigna shows the widest spread at $76.9, indicating the greatest variability in contracted rates, while Blue Cross Blue Shield is the tightest at $32.0.