The ability of Genetic Counselors to order genetic testing has been a point of contention on many levels. Many licensure laws side-step the issue by failing to explicitly allow or prohibit GCs from ordering genetic tests. This can leave GCs in a legislative gray zone, forcing them to depend on their institution's (or 3rd party payor's) varying interpretation of the laws in each state.
Ordering medical testing, and by extension, genetic testing, is typically restricted to physicians and other providers licensed by medical practice boards. Licensing laws for genetic counselors can grant the ability to order genetic tests to those holding a genetic counseling license, but not all of them do. (Are GCs in states without licensure at all able to order genetic tests? Given that they don't have a law that extends that ability to them, we presume no, but we aren't lawyers.)
To determine if a state law allows GCs to order testing, we turn to their Scope of Practice sections. Sometimes the language used there is broad, meaning it could encompass more that what's explicitly mentioned, while other language is narrow, meaning it intends to exclude anything not specifically discussed. Broad and narrow interpretations of such language may vary among different boards, institutions, and attorneys.
We've complied the language surrounding genetic testing within each licensure law below, along with our notes about each state. These notes have NOT been reviewed by legal counsel and should NOT be taken as legal advice. Please seek guidance from the state boards or legal counsel if you need further assistance in interpretation.
(P.S. Have I mentioned we're not lawyers? We're not lawyers. Thanks.)
Key |
|---|
Genetic test ordering explicitly prohibited |
Genetic test ordering explicitly allowed |
Genetic test ordering allowed with a collaborating practice agreement with a physician |
No law exists, or law is not explicit about test ordering |
State | Excerpt Scope of Practice regarding genetic testing | Notes |
|---|---|---|
Alabama | (6) GENETIC COUNSELING. The provision of services by a genetic counselor to do any of the following: ... c. Identify, recommend, and coordinate genetic tests and other genetic related diagnostic studies as appropriate for the genetic assessment consistent with practice-based competencies provided by the ACGC. | May "identify, recommend, and coordinate" testing. Test ordering not explicitly mentioned. |
Alaska | No licensure law | |
Arizona | No licensure law | |
Arkansas | 1) "Genetic counseling" means the process of assisting individuals with understanding and adapting to the medical, psychological, and familial implications of genetic contributions to disease, which includes without limitation: ... (D) Estimating the likelihood of occurrence or recurrence of any potentially inherited or genetically influenced condition, which may involve: ... (iv) Discussing genetic testing to assist in the diagnosis of a condition or determine the carrier status of one (1) or more family members; (E) Assisting the individual, the individual's family, the individual's healthcare provider, or the public to: (iv) Understand genetic tests, including without limitation diagnostic genetic tests, screening tests, or predispositional genetic tests, coordinate testing for inherited disorders, and interpret complex genetic test results | May "discuss, coordinate, and interpret" testing. Test ordering not explicitly mentioned. |
California | “Genetic counseling” means: ... (c) Identifying and coordinating genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment. Nothing in this subsection shall be construed to authorize a genetic counselor to diagnose or treat any genetic disease or condition or other disease or condition; | May "identify and coordinate" testing. Test ordering not explicitly mentioned. CA previously removed language that explicitly prohibited GCs from ordering genetic test, but they did not add language allowing it. Some staff at the GDSP office continue to insist GCs cannot order tests. |
Colorado | No licensure law | |
Connecticut | “Genetic counseling” means the provision of services to individuals, couples, families and organizations by an appropriately trained individual to address the physical and psychological issues associated with the occurrence or risk of occurrence of a genetic disorder, birth defect or genetically influenced condition or disease in an individual or a family. | Genetic testing not mentioned at all in scope of practice. |
Delaware | The “practice of genetic counseling” shall include any or all of the following activities: ... d. Identifying, coordinating and explaining genetic laboratory tests and other diagnostic studies; provided however, that if in the course of providing a genetic counseling service to any client, a genetic counselor finds any indication of disease or condition that requires medical assessment, the genetic counselor shall refer a client to a physician licensed to practice medicine; | May "identify, coordinate and explain" testing. Test ordering not explicitly mentioned. |
Florida | "Scope of practice of genetic counseling" means the process of advising an individual or a family affected by or at risk of genetic disorders, including: ... (c) Identifying, ordering, and coordinating genetic laboratory tests and other diagnostic studies as appropriate for a genetic assessment | GCs may order tests |
Georgia | (6) 'Genetic counseling' means the provision of services by a genetic counselor to... (c) Identify, order, and coordinate genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment consistent with practice based competencies provided by the ACGC; | GCs may order tests |
Hawaii | No licensure law (A licensure law passed, but was never implemented) | |
Idaho | SCOPE OF PRACTICE. A licensed genetic counselor may perform the following acts as a genetic counselor: ... (3) Identify and coordinate genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment; | May "identify and coordinate" testing. Test ordering not explicitly mentioned. |
Illinois | "Genetic counseling" means the provision of services, which may include the ordering of genetic tests, to individuals, couples, groups, families, and organizations by one or more appropriately trained individuals to address the physical and psychological issues associated with the occurrence or risk of occurrence or recurrence of a genetic disorder, birth defect, disease, or potentially inherited or genetically influenced condition in an individual or a family. | GCs may order tests |
Indiana | Sec. 4. "Genetic counseling" means the communication by an individual to estimate, through the following methods, the likelihood of the occurrence or recurrence of a birth defect or a potentially inherited or genetically influenced condition:... (3) Identify, order, and coordinate genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment. | GCs may order tests |
Iowa | Scope of practice. A person licensed pursuant to Iowa Code chapter 148H may do any of the following: ... 3. Identify, order, and coordinate genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment of a patient. | GCs may order tests |
Kansas | No licensure law | |
Kentucky | "Genetic counseling" means the provision of services by a genetic counselor to: ... (c) Identify, order, and coordinate genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment consistent with practice-based competencies provided by ACGC | GCs may order tests |
Louisiana | §1360.103. Collaborative practice agreement; requirements A. Each genetic counselor licensed in accordance with the provisions of this Part shall enter into a collaborative practice agreement with a physician who agrees to work with and provide medical support to the genetic counselor. B. The collaborative practice agreement shall be established as a formal written document that memorializes the relationship between the genetic counselor and the physician and establishes the criteria governing the genetic counselor's performance of each of the following functions: (1) Ordering genetic tests or other tests for the purpose of diagnosing a medical condition or inherited disorder or determining the carrier status of one or more family members of the patient. (2) Selecting the most appropriate, accurate, and cost effective methods of diagnosis. | GCs may order tests with a collaborative agreement with a physician. |
Maine | No licensure law | |
Maryland | (K) (1) “PRACTICE GENETIC COUNSELING” MEANS: …4 – (III) IDENTIFYING, ORDERING, AND COORDINATING GENETIC LABORATORY TESTS AND OTHER DIAGNOSTIC STUDIES, AS APPROPRIATE, FOR PURPOSES OF A GENETIC ASSESSMENT; | GCs may order tests |
Massachusetts | Practice of Genetic Counseling. A communication process conducted by one or more appropriately trained individuals that may include: (a) estimating the likelihood of occurrence or recurrence of a birth defect or of any potentially inherited or genetically influenced condition. This assessment may involve: ... 4. recommending genetic testing or other evaluations to diagnose a condition or determine the carrier status of one or more family members; (b) helping the individual, family, health care provider, or public to: ... 4. select the most appropriate, accurate, and cost-effective methods of diagnosis; and 5. understand genetic or prenatal tests, coordinate testing for inherited disorders, and interpret complex genetic test results; | May "recommend, select, and coordinate" testing. Test ordering not explicitly mentioned. |
Michigan | (i) "Practice of genetic counseling" means provision of any of the following services: ... (iii) Identifying and coordinating appropriate genetic laboratory tests and other diagnostic studies for genetic assessment of a client. | May "identify and coordinate" testing. Test ordering not explicitly mentioned. |
Minnesota | 147F.03 SCOPE OF PRACTICE. The practice of genetic counseling by a licensed genetic counselor includes the following services: ... (4) identifying, coordinating, ordering, and explaining the clinical implications of genetic laboratory tests and other laboratory studies; | GCs may order tests |
Mississippi | Mississippi Law begins enforcement no later than January 1, 2026 SECTION 17. Scope of practice. The practice of "genetic counseling" means the provision of services by an individual who qualifies for a license under this chapter. It includes: ... (d) Identifying, ordering, coordinating, and explaining the clinical implications of genetic laboratory tests and other diagnostic studies; | GCs may order tests |
Missouri | No licensure law | |
Montana | Scope of practice. (1) The practice of genetic counseling involves: ... (c) identifying, ordering, and coordinating genetic laboratory tests and other diagnostic studies as appropriate for genetic assessment; | GCs may order tests |
Nebraska | The scope of practice of a genetic counselor is: ... (3) Identifying and coordinating of genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment; | May "identify and coordinate" testing. Test ordering not explicitly mentioned. |
Nevada | Nevada Law begins enforcement on July 1, 2026 Sec. 4.1. “Genetic counseling” means: ... (c) Identifying, ordering and coordinating genetic laboratory tests as appropriate to assess the genetics of a patient; | GCs may order tests |
New Hampshire | “Practice of genetic counseling” means, for the purposes of advising an individual client, a client’s family, or other licensed health care professional as defined in RSA 326-K:1, VI; ... (3) Identifying and coordinating genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment; | May "identify and coordinate" testing. Test ordering not explicitly mentioned. |
New Jersey | 13:35-14.8 SCOPE OF PRACTICE a) The following is within the scope of practice of a licensed genetic counselor: ... 4) Identifying, coordinating, and explaining the clinical implications of genetic laboratory tests and other diagnostic studies and their results; | May "identify and coordinate" testing. Test ordering not explicitly mentioned. |
New Mexico | L. "Genetic counseling" means a communication process that may include: (1) estimating the likelihood of occurrence or recurrence of any potentially inherited or genetically influenced condition or congenital abnormality. Genetic counseling may involve: ... (d) determining appropriate genetic testing or other evaluations to diagnose a condition or determine the carrier status of one or more family members; (2) helping an individual, family or health care provider to: (d) select the most appropriate, accurate and cost-effective methods of diagnosis; and (e) understand genetic or prenatal tests, coordinate testing for inherited disorders and interpret complex genetic test results; and | May "determine, select, and coordinate" testing. Test ordering not explicitly mentioned. |
New York | No licensure law | |
North Carolina | No licensure law | |
North Dakota | North Dakota Law will go into effect August 1, 2025 SECTION 1. AMENDMENT. Subsection 2 of section 43-60-02 of the North Dakota Century Code is amended and reenacted as follows: 2. Genetic testing may be ordered by a licensed genetic counselor or in coordination with a North Dakota licensed health care provider acting within the provider's scope of practice and privileged to do so. ... Nothing in this chapter authorizes a genetic counselor to practice medicine, including treatment or medical management of a patient. If, in the course of providing genetic counseling to a client, a genetic counselor finds any indication of a disease or condition that requires medical assessment or treatment, the genetic counselor shall refer the client to a provider licensed to practice medicine. | GCs may order tests |
Ohio | (B) A genetic counselor may enter into a collaborative agreement with a physician who agrees to work with and provide medical support to the genetic counselor. The agreement shall be established as a written, formal document that memorializes the relationship between the genetic counselor and the physician and establishes the criteria governing the genetic counselor's performance of both of the following: (1) Order genetic or other tests for the purpose of diagnosing a medical condition or inherited disorder or determining the carrier status of one or more of the patient's family members; (2) Select the most appropriate, accurate, and cost-effective methods of diagnosis. | GCs may order tests with a collaborative agreement with a physician. |
Oklahoma | 4. “Genetic counseling” means a communication process, conducted by one or more appropriately trained individuals, that includes: a. estimating the likelihood of occurrence or recurrence of a birth defect or of any potentially inherited or genetically influenced condition. Such assessment may involve: ... (4) discussion of genetic testing or other valuations to diagnose a condition or determine the carrier status of one or more family members, b. helping an individual, the individual’s family, a health care provider, or the public to: ... (4) select the most appropriate, accurate and cost effective methods of diagnosis, or (5) understand genetic or prenatal tests, coordinate testing for inherited disorders, and interpret genetic test results | May "discuss, select, and coordinate" testing. Test ordering not explicitly mentioned. |
Oregon | 676.730 Definitions for ORS 676.730 to 676.748. As used in ORS 676.730 to 676.748: (1) “Genetic counseling” means the practice of assisting patients in understanding and adapting to the medical, psychological and familial implications of genetic conditions, including: ... (c) Identifying and coordinating genetic laboratory tests and other diagnostic studies appropriate for genetic assessment | May "identify and coordinate" testing. Test ordering not explicitly mentioned. |
Pennsylvania | (3) Nothing in this subsection shall be construed to authorize a genetic counselor to diagnose, test or treat any genetic disease or condition or other disease or condition. | GCs may NOT order tests |
Rhode Island | (7) “Practice of genetic counseling” means a communication process, conducted by one or more appropriately trained individuals that may include: ... (iii) Identifying, ordering, and coordinating genetic laboratory tests as appropriate for the genetic assessment; | GCs may order tests |
South Carolina | 8) "Practice of genetic counseling" means: ... (c) identify and order genetic laboratory tests as appropriate for the genetic assessment; | GCs may order tests |
South Dakota | Genetic counseling defined. For the purposes of this chapter, genetic counseling is a communication process, conducted by appropriately trained persons that includes: ... (2) Assessing the likelihood of the occurrence or recurrence of an abnormality in the fetus in structure, function, or metabolism or of any potentially inherited or genetically influenced condition. The assessment may include the following: ... (d) Ordering genetic testing or other evaluations, consistent with the referral and reporting requirements of this chapter, to diagnose a condition or determine the carrier status of one or more family members; and | GCs may order tests |
Tennessee | 63-6-803. Scope of genetic counseling. (a) Genetic counseling is a communication process, conducted by one (1) or more appropriately trained individuals, that includes: (1) Estimating the likelihood of occurrence or recurrence of any potentially inherited or genetically influenced condition. This assessment may involve: ... (D) Recommending genetic testing or other evaluations to assist in the diagnosis of a condition or determine the carrier status of one (1) or more family members; (2) Helping the individual, family, health care provider or public to: (D) Select the most appropriate, accurate, and cost-effective methods of diagnosis; and (E) Understand genetic tests, including, but not limited to, diagnostic genetic tests, screening tests, or predispositional genetic tests, coordinate testing for inherited disorders, and interpret complex genetic test results; | May "recommend, select, and coordinate" testing. Test ordering not explicitly mentioned. |
Texas | No licensure law | |
Utah | (2) "Practice of genetic counseling" means the communication process which deals with the human problems associated with the occurrence, or the risk of occurrence, of a genetic disorder in a family, including the provision of services to help an individual or family: (a) comprehend the medical facts, including the diagnosis, probable cause of the disorder, and the available management; (b) appreciate the way heredity contributes to the disorder and the risk of occurrence in specified relatives; (c) understand the alternatives for dealing with the risk of occurrence; (d) choose the course of action which seems appropriate to them in view of their risk, their family goals, and their ethical and religious standards, and to act in accordance with that decision; and (e) make the best possible psychosocial adjustment to the disorder in an affected family member or to the risk of occurrence of that disorder. | Genetic testing not mentioned at all in scope of practice. |
Vermont | No licensure law | |
Virginia | "Practice of genetic counseling" means... (iii) ordering genetic laboratory tests and other diagnostic studies necessary for genetic assessment | GCs may order tests |
Washington | Collaborative agreement. (1) Under a collaborative agreement, a licensed genetic counselor may order laboratory tests or recommend other evaluations to diagnose a hereditary condition or determine the carrier status of one or more family members, including testing for inherited disorders. The collaborative agreement shall include: (a) A written statement identifying and signed by the collaborating physician and genetic counselor who are party to the agreement. (b) A general statement of the procedures, decision criteria, or categories of care that a genetic counselor is to follow when ordering genetic tests or other evaluations. (c) A selection of the most appropriate, accurate, and cost-effective methods of diagnosis. (2) Any modification to the collaborative agreement shall be treated as a new agreement. (3) A collaborative agreement must be reevaluated at least every two years and the document reexecuted if any modification is made. (4) A signed copy of the collaborative agreement must be maintained by all parties and available for inspection by the department upon request. | GCs may order tests with a collaborative agreement with a physician. |
West Virginia | No licensure law | |
Wisconsin | 3) “Genetic counseling” means to do any of the following: ... (c) Identify, coordinate, and order genetic laboratory tests as appropriate for a genetic assessment. | GCs may order tests |
Wyoming | No licensure law |
