To the Editor: Dr Tung’s review of the difficult decisions faced by women with a BRCA mutation mentioned the importance of genetic counseling in the process of clinical decision making. Decisions about definitive breast surgery, prophylactic oophorectomy, and fertility options such as preimplantation diagnosis increasingly are being informed by the awareness of a BRCA mutation. Tung commented on the importance of compensating hospitals and physicians for trained genetic counselors. Fragmented reimbursement of genetic services has limited integration of genetic counselors into a collaborative oncology care model. However, we propose reframing the question from compensation of hospitals and physicians to determining how genetic counselors—many of whom are licensed to practice independently—could be reimbursed in a manner that is in the best interests of patients, clinicians, and health care systems. Currently Medicare does not recognize genetic counselors as “providers.” Recognition would lead to increased coverage by payers and benefit patients by improving access to genetic counseling. Institutions in which genetic counselors practice with physicians would benefit by increasing their efficiency in delivering genetic services. Genetic counselor certification ensures they are proficient in selecting appropriate genetic tests and interpreting them correctly. Appropriate use of genetic testing can reduce health system costs, contrary to a recent study in which a majority of nongeneticist physicians would order unnecessary or incorrect BRCA testing at considerable additional cost. Finally, Tung states that “most genetic counseling programs cost more than they generate in revenue.” This may reflect an incomplete accounting. Any truly useful calculation of the institutional value of genetic counseling programs must include a careful study of the “downstream revenue” institutions receive from performing surveillance, prophylactic surgery, or cancer treatment for individuals with BRCA mutations.