More than a decade after the successful mapping of the human genome, clinical genomics is starting to permeate important parts of patient care. Although the field has fallen far short of the transformational therapeutic impact once widely predicted, the use of genomic interventions is rising rapidly, if not always appropriately. Avoidable patient harm and excess costs mix with significant clinical and economic benefits. A health policy community long fluent in the argot of DRGs and billing codes needs to acquire similar proficiency in the language of DNA and genetic codes. This paper, by Michael Millenson, a senior policy consultant to the Urban Institute, examines what's hype, what's hopeful and what's starting to make a genuine difference in clinical genomics.