Instructions for calling your insurance company for Group Genetic Counseling

Medical billing is very complicated and always involves procedure codes (CPT codes). The following instructions can be applied for Montefiore’s group genetic counseling only.

  1. Call the number on the back of your health insurance card.
  2. Tell the insurance representative that you want to check if genetic counseling is covered under your plan.
  3. If they ask for a diagnosis code, tell them Z31.43 if you are female and Z31.44 if you are male. Not all insurance representatives will ask for this. This is the “indication” for your genetic counseling visit.
  4. If they ask for a procedure code, give them the CPT code: 99411. The insurance representative may take a few minutes to look into it and will come back with an answer for you
  5. Make sure to ask the following questions and keep a record of all the answers:
  • Is the provider in-network?
  • Do I have a co-insurance or unmet deductible?
  • Does my insurance plan have a policy statement regarding genetic counseling?
  • If so, this might give you more information regarding your specific coverage for genetic testing. Usually this is available on your insurance company’s website. You can request a copy of this policy as well.
  • What is the reference number for this call?
  • What is the name of the insurance representative you are speaking with?