Summary & Overview
CPT 0477U: Pharmacogenomic Mental Health Medication Report
CPT code 0477U denotes a Proprietary Laboratory Analyses (PLA) test — the RightMed® Mental Health Medication Report from OneOme LLC — which evaluates 14 genes plus the CYP2D6 copy number variant to report pharmacogenomic phenotypes and gene–drug interactions for psychiatric medications. This code matters nationally as pharmacogenomic testing increasingly informs medication selection, adverse effect risk reduction, and personalized psychiatric care across ambulatory and specialty settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes payer coverage patterns, coding and billing considerations, and clinical context for the test’s use. Readers will find benchmarks for utilization and common payer approaches, a concise explanation of the clinical implications of the 14-gene panel and CYP2D6 copy number assessment, and summaries of typical site-of-service workflows for ordering and reporting results. The material also outlines typical modifiers encountered in claims (listed separately) and clarifies that the code is PLA-specific to OneOme’s RightMed® report. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 0477U is a Proprietary Laboratory Analyses (PLA) code that applies only to the RightMed® Mental Health Medication Report from OneOme LLC. The test analyzes 14 genes and the CYP2D6 copy number variant to characterize drug metabolism phenotypes and gene–drug interactions relevant to psychiatric medications. The report translates genetic findings into reported phenotypes and documented gene–drug interactions specific to mental health medication management.
Service type: Genetic/pharmacogenomic testing for psychiatric medication management
Typical site of service: Clinical laboratory or reference laboratory, with results used by outpatient psychiatric clinics, primary care offices, and other ambulatory care settings for medication selection and management.
Clinical & Coding Specifications
Clinical Context
A 34-year-old patient with treatment-resistant major depressive disorder is evaluated in an outpatient psychiatric clinic after inadequate response and adverse effects from multiple antidepressant trials. The psychiatrist orders the RightMed® Mental Health Medication Report (0477U) to assess pharmacogenomic factors influencing drug metabolism and gene–drug interactions. The clinical workflow: the clinician documents the indication and obtains informed consent; a buccal swab or blood sample is collected in the outpatient lab or clinic; the specimen is sent to OneOme LLC for proprietary analysis of 14 genes plus CYP2D6 copy number; results are returned as a report describing predicted metabolic phenotypes, gene–drug interactions, and medication selection/optimization information. The treating clinician reviews the report to interpret phenotypes (for example, CYP2D6 poor or ultrarapid metabolizer) and gene–drug interaction guidance in the context of the patient’s psychiatric medications, documents the findings in the medical record, and applies the information to optimize pharmacotherapy and reduce risk of adverse effects.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default / No modifier | When no special circumstances apply to the service. |