Summary & Overview

CPT 0476U: RightMed® Mental Health Pharmacogenomic Panel

CPT code 0476U designates the RightMed® Mental Health Gene Report from OneOme LLC, a proprietary pharmacogenomic laboratory test that evaluates 14 genes and the CYP2D6 copy number variant to generate drug metabolism phenotypes for psychiatric medication management. As a PLA code, 0476U is specific to a single manufacturer’s test and signals to payers that the service is a distinct, proprietary assay. Nationally, these tests inform individualized prescribing and are increasingly included in coverage discussions because of potential to reduce adverse drug events and improve therapeutic response in mental health care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical service setting, and the kinds of benchmarks and policy considerations commonly reviewed for PLA-level pharmacogenomic tests. The publication summarizes payer coverage themes, reimbursement benchmarking topics, and clinical context for use in psychiatric prescribing. It also identifies where input data were unavailable and highlights areas where payers and providers commonly seek clarity when evaluating proprietary lab codes.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare0476UCPTProprietary Laboratory AnalysesPharmacogenomicsMental HealthGenetic TestingRightMedCYP2D6Laboratory

Billing Code Overview

CPT code 0476U is a Proprietary Laboratory Analyses (PLA) code that applies exclusively to the RightMed® Mental Health Gene Report produced by OneOme LLC. The test analyzes 14 genes plus the CYP2D6 copy number variant to characterize drug metabolism phenotypes relevant to psychiatric medication management.

Service type: Genetic testing — pharmacogenomic panel for mental health prescribing

Typical site of service: Clinical laboratory or ambulatory outpatient setting where specimen collection and laboratory processing occur.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A patient with a history of major depressive disorder or generalized anxiety disorder who has had incomplete response or adverse reactions to multiple psychotropic medications presents to an outpatient psychiatric clinic. The clinician orders the RightMed® Mental Health Gene Report (0476U) from OneOme LLC to characterize pharmacogenomic variants across 14 genes and CYP2D6 copy number variation that affect psychotropic drug metabolism and drug–gene interactions. A typical workflow: the provider obtains informed consent and a cheek swab or saliva specimen collected either in clinic or via a kit sent to the patient; the specimen is sent to the performing laboratory; results are returned in an electronic report identifying metabolizer phenotypes and medication-specific guidance for the treating psychiatrist or primary care clinician. Results are reviewed during a follow-up visit or telehealth encounter to inform medication selection, dosing adjustments, or avoidance of specific agents based on genotype-predicted metabolism and actionable gene–drug interactions.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional interpretation component, if separated from technical services.
`TC`	Technical component	Use when billing only technical component (laboratory processing) separate from professional interpretation.
`52`	Reduced services	Use when the test was partially performed or limited compared to full protocol.
`53`	Discontinued procedure	Use if specimen collection or testing was started but discontinued for patient safety or other valid reason.
`59`	Distinct procedural service	Data not available in the input.
`62`	Two surgeons	Use when two qualified providers jointly perform distinct portions of service; rarely applicable for labs but included in list of common modifiers.
`76`	Repeat procedure by same physician	Data not available in the input.
`77`	Repeat procedure by another physician	Data not available in the input.
`91`	Repeat clinical diagnostic test	Data not available in the input.

Taxonomy Code	Specialty	Notes
2084P0800X	Psychiatry	Psychiatrists order and interpret reports to guide psychotropic prescribing.
207Q00000X	Clinical Laboratory	Clinical laboratory directors and molecular diagnostics labs perform the assay and report results.
208M00000X	Family Medicine	Primary care physicians may order testing for medication management in mental health.
208000000X	Internal Medicine	Internists may use reports to adjust psychiatric medications or manage comorbidities.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	Common indication for pharmacogenomic testing to inform antidepressant selection and dosing.
`F33.9`	Major depressive disorder, recurrent, unspecified	Used when patients with recurrent depression need medication optimization guided by genetics.
`F41.1`	Generalized anxiety disorder	Anxiety disorders often treated with medications whose metabolism is impacted by tested genes.
`F31.9`	Bipolar disorder, unspecified	Mood stabilizers and antipsychotics metabolized variably; pharmacogenomic data can inform therapy choices.
`F45.41`	Pain disorder exclusively related to psychological factors	When psychotropic medication choices intersect with pain management, metabolism data can be relevant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`81479`	Unlisted molecular pathology procedure	May be used when no specific molecular code exists, but not applicable when `0476U` is the proprietary PLA code uniquely identifying the RightMed report.
`80305`	Drug testing, presumptive, any number of drug classes; qualitative, non-confirmatory	Ancillary toxicology testing sometimes performed in medication monitoring alongside pharmacogenomic testing.
`99000`	Handling and/or conveyance of specimen	Ancillary service code for shipping/handling that may be billed by some laboratories as part of the testing workflow.