Summary & Overview
CPT 0423U: Genomind Pharmacogenetics Report – Full
CPT code 0423U designates a Proprietary Laboratory Analyses (PLA) test for the Genomind® Pharmacogenetics Report – Full, a 26-gene pharmacogenetic assay using a buccal swab. The code is specific to a single manufacturer's proprietary test and matters nationally as pharmacogenetic testing increasingly informs psychiatric medication selection and safety. Payers and clinicians reference PLA codes like 0423U when evaluating coverage policies, billing practices, and clinical utility for personalized psychotropic therapy. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the core clinical function of the test, typical sites of service, and the scope of the assay's interpretive output. The publication summarizes payer coverage patterns and benchmark context where available, highlights relevant policy considerations for proprietary pharmacogenetic assays, and situates the test within clinical practice for psychiatric medication management. Data not available in the input is noted where applicable; the focus remains on code definition, clinical application, and the payer landscape for national audiences.
Billing Code Overview
CPT code 0423U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the Genomind® Pharmacogenetics Report – Full, manufactured by Genomind® Inc. The test analyzes 26 genes from a buccal (cheek) swab specimen to identify genetic variants associated with psychiatric medication response. The report provides an algorithmic interpretation of patient genetic impact on drug metabolism and summarizes potential gene–drug interactions and toxicity risk for psychotropic medications.
Service type: Clinical pharmacogenetic laboratory testing with algorithmic analysis and interpretive report
Typical site of service: Clinical laboratory or independent diagnostic testing facility (buccal swab collection in outpatient clinics, psychiatric practices, or specimen collection centers)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or adolescent receiving psychiatric care who is experiencing inadequate response, intolerable side effects, or multiple medication trials for mood, anxiety, psychotic, or attention-deficit disorders. A treating psychiatrist, psychiatric nurse practitioner, or primary care clinician orders the Genomind® Pharmacogenetics Report – Full (0423U) to inform psychotropic medication selection and dosing. A buccal (cheek) swab is collected in clinic or sent to a participating laboratory; the specimen is processed by Genomind® Inc., which analyzes 26 genes and runs an algorithmic interpretation. The laboratory report returns results identifying variants that affect drug metabolism, likely gene–drug interactions, and toxicity risk. The clinician reviews the report in follow-up, documents how genetic findings influence medication choice or monitoring, and incorporates the results into the medication management plan. Typical sites of service include outpatient behavioral health clinics, psychiatric offices, primary care offices managing mental health, and specialty pharmacy-associated collection sites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default proprietary code indicator used by some payors | Rarely appended; use only if requested by payer for PLA reporting |