Genetic counseling gathers critical family history, patient history, and other factors to be analyzed and shared with the SoonerCare member to help them understand and adapt to the medical, psychosocial and familial contributions to potential or realized birth defects.
Who Qualifies For This Service?
- Pregnant and/or up to 60 days postpartum SoonerCare members
- Soon-to-be-Sooners members while they are still pregnant. Mother’s coverage ends at the time of delivery.
Why Genetic Counseling?
- Advance maternal age
- Abnormal maternal serum first or second screening
- Previous child or current fetus/infant with an abnormality
- Parent is a known carrier or has a family history of a genetic condition
- Parent was exposed to a known or suspected reproductive hazard
- Previous fetal demise, stillbirth, or neonatal death involving know/suspected abnormalities
- History of recurrent pregnancy loss
- Parent(s) are in an ethnic or racial group associated with an increased risk for specific genetic conditions
Who Qualifies To Provide The Service?
Genetic counselors with a current OHCA provider contract who are licensed or board certified Genetic Counselors in the state of Oklahoma.
What Procedures Are Covered Under Genetic Counseling?
- 96040 – Medical Genetic Counseling
What Are The Service Limitations And Conditions?
- Up to 6 total units per pregnancy including 60 days postpartum care (1 unit = 30 minutes)
- Member must be referred by obstetrician/gynecologists or pediatrician
- Services must be provided in office or outpatient setting
- No separate reimbursement for inpatient services
- Genetic counselors who are employed by or remunerated by another provider may not bill the SoonerCare program directly for services if that billing would result in duplicate payment for the same service
- Services must be medically necessary
What Documentation Must Be Maintained By The Genetic Counselor
Services must be documented in member’s medical record to include:
- Date of service
- Start and stop time for each session
- Practitioner’s signature
- Pedigree, and/or review and interpretation of family history
- Recommendations and plan of care