Summary & Overview

CPT 0350U: Pharmacogenomic NGS 27-Gene Panel (RightMed® Gene Report)

CPT code 0350U designates the RightMed® Gene Report from OneOme® LLC, a Proprietary Laboratory Analyses (PLA) test that uses next-generation sequencing (NGS) of whole blood or buccal swab specimens to analyze 27 genes relevant to drug metabolism and function. As a PLA code, 0350U applies only to this single, manufacturer-specific assay and identifies a targeted pharmacogenomic service increasingly used in precision prescribing and medication safety programs.

Major national payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report summarizes payer coverage posture and common billing practices for the test, and highlights clinical context for pharmacogenomic testing in medication management.

Readers will learn the clinical purpose of the assay, where the test is typically performed, and what billing stakeholders commonly track for PLA codes: single-source specificity, specimen types, and service line placement. The publication also provides benchmarks and policy updates relevant to laboratory billing for proprietary genetic tests, plus practical information on documentation expectations and typical sites of service. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0350UCPTpharmacogenomicsproprietary-lab-analysisnext-generation-sequencingNGSgenetic-testinglaboratory-billing

Billing Code Overview

CPT code 0350U is a Proprietary Laboratory Analyses (PLA) code specific to the RightMed® Gene Report from OneOme® LLC. The test uses next-generation sequencing (NGS) of a whole blood or buccal (cheek) swab specimen to analyze 27 genes for variants relevant to drug metabolism and function.

Service type: Clinical laboratory genetic testing using NGS for pharmacogenomic analysis
Typical site of service: Clinical laboratory or outpatient collection site (blood draw or buccal swab)

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or pediatric outpatient referred by a primary care provider, psychiatrist, pain specialist, cardiologist, or oncologist for pharmacogenomic testing to optimize medication selection and dosing. The patient provides a whole blood or buccal (cheek) swab specimen during an office visit or at an outpatient laboratory. The clinical workflow includes: pre-test counseling and informed consent, sample collection (venipuncture or buccal swab), specimen shipment to the performing laboratory (OneOme® LLC), next-generation sequencing (NGS) analysis of 27 pharmacogenes, a laboratory report (RightMed® Gene Report) that interprets variants relevant to drug metabolism and function, and return of results to the ordering clinician. Results inform medication choice, dose adjustments, drug–drug interaction considerations, and documentation in the electronic health record for future prescribing decisions.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the interpreting physician's portion of a test if the lab charges separately for professional interpretation.
`TC`	Technical component	Use when billing only for the laboratory's technical component (sequencing and analysis) separate from professional interpretation.
`52`	Reduced services	Use when the test is partially performed or a limited panel was completed compared with the full service.
`53`	Discontinued procedure	Use when testing was started but terminated for patient-related or specimen-related reasons prior to completion.
`59`	Distinct procedural service	Use when another unrelated service is performed on the same day and needs to be distinguished (note: `59` is not in the provided modifier list; not applicable here).
`22`	Increased procedural services	Use when documentation supports that the complexity of interpretation or reporting significantly exceeded the usual for the test.
`76`	Repeat procedure by same physician	Use when the identical test is repeated by the same ordering or performing provider on the same day (note: `76` not in provided list; not applicable).
`78`	Unplanned return to the operating/procedure room by same physician following initial procedure for a related procedure during the postoperative period	Not typically applicable to laboratory testing; included in the provided list for completeness when applicable.
`80`	Assistant surgeon	Not applicable to laboratory procedures but listed among possible modifiers; not commonly used for this code.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not applicable to a laboratory genetic test but included in raw modifiers.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Not applicable to this procedure.
`QX`	CRNA service: when performed with medical direction	Not applicable to this procedure.
`QY`	Medical direction of one CRNA by an anesthesiologist	Not applicable to this procedure.

Taxonomy Code	Specialty	Notes
208D00000X	Medical Genetics & Genomics	Physicians who order and interpret genetic testing and integrate results into care.
207Q00000X	Psychiatry & Neurology	Psychiatrists commonly order pharmacogenomic testing for psychotropic medication management.
207L00000X	Pain Medicine	Pain specialists use pharmacogenomic information to guide opioid and adjuvant therapy choices.
207R00000X	Cardiovascular Disease	Cardiologists may order testing to guide antiplatelet and cardiovascular medication selection.
207K00000X	Clinical Pharmacology	Clinical pharmacologists and pharmacists who consult on pharmacogenomics and medication management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z13.79`	Encounter for screening for other metabolic disorders	Used when ordering pharmacogenomic screening in an asymptomatic patient to inform medication management.
`F33.1`	Major depressive disorder, recurrent, moderate	Pharmacogenomic testing can guide selection and dosing of antidepressants.
`I20.9`	Angina pectoris, unspecified	Pharmacogenomic results may influence antiplatelet or cardiovascular drug therapy.
`G89.29`	Other chronic pain	Pain management clinicians may use pharmacogenomic data to tailor opioid and adjunctive therapies.
`Z79.899`	Other long term (current) drug therapy	Relevant when patients are on chronic medications and testing informs ongoing therapy adjustments.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`0350U`	RightMed® Gene Report; NGS analysis of 27 genes for pharmacogenomic variants (Proprietary Laboratory Analyses)	Primary code to report this specific proprietary test from OneOme® LLC.
`0000U`	Data not available in the input.	Data not available in the input.
`81225`	CYP2D6 (cyclooxygenase 2) gene analysis, genotyping, common variants (example of single-gene pharmacogenetic test)	Often performed as an alternative or supplement when targeted single-gene results are required instead of a multi-gene panel.
`81226`	CYP2C19 genotyping	Common single-gene test relevant to antiplatelet and antidepressant metabolism; may be ordered when a focused analysis is desired.
`81479`	Unlisted molecular pathology procedure	Used when no specific CPT or PLA code exists for a unique molecular test; not used when `0350U` is applicable.
`0080U`	Data not available in the input.	Data not available in the input.