Summary & Overview

CPT 0411U: IDgenetix® Pharmacogenomic Test for Psychotropic Medication Management

CPT code 0411U designates a Proprietary Laboratory Analyses (PLA) test specific to IDgenetix® from Castle Biosciences Inc., a pharmacogenomic assay that analyzes 15 genes from a buccal swab to inform psychotropic medication choices by flagging potential drug–drug and drug–gene interactions. As a PLA code, 0411U is unique to this one test and signals that payers and clinicians are addressing an emerging, commercially owned diagnostic with individualized clinical utility. Nationally, the code matters because pharmacogenomic testing for mental health medications is a growing area of precision medicine with implications for medication safety, prescribing efficiency, and utilization management.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national overview of the code’s clinical purpose, typical sites of service, and the service type. The publication also outlines payer coverage landscape and common billing practices, summarizes available benchmarks where present, and highlights policy and coding considerations relevant to laboratories, clinicians, and billing teams. Data not available in the input will be identified explicitly in relevant sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0411UCPTPLApharmacogenomicspsychotropic-medicationsgenetic-testingbuccal-swabprecision-medicine

Billing Code Overview

CPT code 0411U is a Proprietary Laboratory Analyses (PLA) code that applies only to a single, manufacturer-specific test: IDgenetix® from Castle Biosciences Inc. The assay analyzes 15 genes from a buccal (cheek) swab specimen and uses an algorithmic analysis to generate a report listing all psychotropic medications with indications of potential drug–drug interactions and drug–gene interactions for the patient.

Service Type: Genetic/pharmacogenomic testing for psychotropic medication management

Typical Site of Service: Clinical laboratory or ambulatory collection site (buccal swab collected in outpatient or office settings and sent to the performing laboratory).

Clinical & Coding Specifications

Clinical Context

A 35-year-old adult with a history of major depressive disorder and partial response to multiple antidepressant trials presents to a psychiatric clinic for medication optimization. The treating psychiatrist orders the IDgenetix® pharmacogenomic test (reportable with CPT code 0411U) to analyze 15 genes from a buccal swab specimen. The lab performs genotyping and an algorithmic review that cross-references the patient’s gene variants with psychotropic medications, producing a report that lists all psychotropic medications with indicated gene–drug and drug–drug interaction concerns. Typical clinical workflow: the clinician collects a buccal swab during an outpatient behavioral health visit or sends a test kit to the patient; the sample is shipped to the testing laboratory; the laboratory performs the proprietary analysis and returns an actionable report to the ordering clinician; the clinician reviews the report to inform medication selection or dosing decisions and documents results in the medical record.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard billing	Use when no special circumstance applies to the laboratory test billing.
`26`	Professional component	Use if billing for the professional interpretation component separately from the technical component.
`TC`	Technical component	Use if billing only for the laboratory technical component (processing and analysis).
`52`	Reduced services	Use when the test was partially reduced or not fully performed but still reported.
`53`	Discontinued procedure	Use when the specimen collection or test was started but discontinued for documented reasons.
`59`	Data not provided in input	Data not available in the input.
`62`	Two surgeons	Use only when two qualified providers are involved and payer requires reporting — rarely applicable to lab tests.
`76`	Data not provided in input	Data not available in the input.
`78`	Unplanned return to the operating/procedure room by the same physician following initial procedure	Not typically applicable to PLA codes; include only if clinical circumstance justifies.
`80`	Assistant surgeon	Not typically applicable to lab testing; include only if payer-specific rules require.

Taxonomy Code	Specialty	Notes
207Q00000X	Psychiatry	Ordering clinicians commonly include psychiatrists managing psychotropic medication regimens.
207L00000X	Neurology	Neurologists may order pharmacogenomic testing for neuropsychiatric medication management.
363LP0800X	Pathology & Laboratory Medicine	Laboratory specialists perform and oversee testing and result verification.
208000000X	Family Medicine	Primary care physicians may order testing for medication guidance in behavioral health contexts.
207K00000X	Clinical Pharmacology	Clinical pharmacists involved in medication management and interpretation of pharmacogenomic results.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	Common indication for pharmacogenomic testing to guide antidepressant selection and dosing.
`F33.1`	Major depressive disorder, recurrent, moderate	Used when patients have recurrent depression and need medication optimization informed by genetic results.
`F41.1`	Generalized anxiety disorder	Pharmacogenomic data can inform choice of anxiolytic or antidepressant agents.
`F20.9`	Schizophrenia, unspecified	Antipsychotic selection and metabolism considerations may prompt testing.
`F11.20`	Opioid dependence, uncomplicated	Medication interactions and metabolizer status can affect psychotropic co‑prescribing and risk management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81002`	Urinalysis, by dipstick or tablet reagent, non-automated, without microscopy	May be performed in the same visit for baseline medication monitoring or when assessing side effects; not directly related to the PLA.
`83001`	Hemoglobin; glycosylated (A1c)	Occasionally ordered by primary care at the same visit for metabolic monitoring when initiating psychotropic medications with metabolic risk.
`82270`	Blood, occult; fecal immunoassay for hemoglobin, qualitative	Unrelated routine test occasionally ordered during comprehensive evaluation but not specific to pharmacogenomic testing.
`99000`	Handling and/or conveyance of specimen for transfer from the physician to a laboratory	Used when billing for specimen collection and shipping logistics associated with sending buccal swab to the reference lab.
`0000U`	Proprietary Laboratory Analyses example code	Example PLA codes may be performed in the same laboratory portfolio; used here as a reference to analogous single-manufacturer tests.