Summary & Overview
CPT 0175U: Genomind Professional PGx Express CORE 15-Gene Psychiatric Panel
CPT code 0175U represents a Proprietary Laboratory Analyses (PLA) billing code for the Genomind® Professional PGx Express™ CORE test, a 15-gene panel that assesses gene sequence variants relevant to psychiatric medication selection. As a PLA code, 0175U applies to one specific commercial test and signals the growing role of targeted pharmacogenomic assays in personalized behavioral health care nationwide. This code matters because it standardizes reporting for a proprietary psychiatric pharmacogenomic assay, enabling clearer claims processing and activity tracking across payers.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and coding workflows vary across these payers, affecting prior authorization, clinical documentation, and reimbursement pathways for pharmacogenomic testing.
Readers will learn the clinical purpose of the code, the typical service setting and delivery model, and which major payers are relevant to coverage discussions. The publication also provides benchmarks and policy context for billing and claims handling of PLA pharmacogenomic tests, summarizes common modifiers used with laboratory claims, and outlines the implications of proprietary coding for laboratory reporting and payer communications.
Billing Code Overview
CPT code 0175U is a Proprietary Laboratory Analyses (PLA) code for the Genomind® Professional PGx Express™ CORE test. This test evaluates gene sequence variants across 15 genes to identify potential pharmacogenomic markers that may indicate appropriate psychiatric therapies for individual patients.
Service type: Genetic/pharmacogenomic laboratory testing
Typical site of service: Clinical laboratory or independent diagnostic testing facility (IDTF)
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with a history of major depressive disorder and partial response to multiple antidepressants presents to a psychiatric clinic for medication optimization. The treating psychiatrist orders a pharmacogenomic test to inform selection and dosing of psychotropic medications. A buccal swab or blood sample is collected in clinic and sent to the Genomind laboratory for the Genomind® Professional PGx Express™ CORE test. The laboratory performs targeted genotyping of 15 genes associated with psychotropic drug metabolism and response. Results are reported to the ordering clinician and integrated into the medication management plan during a follow-up visit. Typical sites of service include outpatient psychiatry clinics, primary care offices managing psychiatric medications, and specialty behavioral health centers. Billing is submitted using the PLA code 0175U for the proprietary Genomind test; specimen handling, collection supplies, and laboratory technical and professional components may be billed separately if applicable. Patient consent for genetic testing and counseling documentation are completed per clinic protocol prior to specimen collection.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no modifier applies to the claim |
26 | Professional component | Use when billing only the physician professional interpretation component separate from the lab technical component