Billing options

OneOme’s strives to provide cost-effective pharmacogenomic testing and tools for providers across the globe. That’s why we’ve created a billing process that supports different payment options, depending on how the test is ordered.

Payment options include:

  • Patient self pay (U.S. only)

  • Institutional billing

  • Insurance billing (U.S. only)

Our client services team can help you identify the best billing option for your scenario. Contact us for more information.

Patient self-pay (U.S. only)

For tests ordered by a patient’s provider, patients may pay for the test as part of the provider’s order process or they can choose to have OneOme reach out to collect payment afterwards. OneOme accepts payments from all major credit cards and HSA accounts. In addition, we offer interest-free payment plans when needed. Please contact us for more information.

Please note that a patient’s sample will not be processed until payment is collected or a payment plan has been established.

For RightMed Tests ordered through the independent provider network, OneOme accepts payment from credit cards and HSA accounts (insurance billing is not available for this option).

Institutional billing

Institutional billing is available with or without a contract, but most institutions choose to secure contracted pricing. Testing is not invoiced until a report has been delivered. We offer a variety of payment options including check, credit card, or wire transfer. Please contact us for more information.

Insurance billing

Our goal is to provide patients the lowest cost option available to them. Depending on a patient’s insurance, their maximum out-of-pocket cost may vary.

Medicare, Medicaid, and TRICARE

For government-funded insurance programs, such as Medicare, Medicaid, Managed Medicaid Plans, or TRICARE, a patient’s out-of-pocket cost will be $0. Medicare Advantage plans may have a copayment or deductible requirement.

Private insurance

For RightMed Tests ordered by a patient's provider where insurance billing is selected, OneOme will determine if the patient qualifies for our Financial Assistance Program. Those who qualify will receive a letter from OneOme with their maximum patient responsibility amount and information on what to expect during the billing process.

OneOme Financial Assistance Program (FAP)

OneOme offers financial assistance to reduce out-of-pocket costs for qualified patients in the U.S. to $299 or less. To be eligible patients must have private insurance and meet income requirements (pre-tax household income up to 600 percent of the federal poverty level).

Use the table below to predict your out-of-pocket cost of the RightMed Test based on household size and income. Income values are pre-tax and based on 2021 poverty guidelines for the 48 contiguous states and the District of Columbia (aspe.hhs.gov/poverty-guidelines). For each additional member in your household add $4,540 to the income range.

Cost under private insurance with OneOme's FAP
Household size Income range Patient's RightMed Test cost
1 $0 to $12,880 $49
1 $12,881 to $25,760 $99
1 $25,761 to $38,640 $149
1 $38,641 to $51,520 $199
1 $51,521 to $64,400 $249
1 $64,401 to $77,280 $299
1 $77,281 + OneOme offers patient self-pay ($349)
2 $0 to $17,420 $49
2 $17,421 to $30,300 $99
2 $30,301 to $43,180 $149
2 $43,181 to $56,060 $199
2 $56,061 to $68,940 $249
2 $68,941 to $81,820 $299
2 $81,821 + OneOme offers patient self-pay ($349)
3 $0 to $21,960 $49
3 $21,961 to $34,840 $99
3 $34,841 to $47,720 $149
3 $47,721 to $60,600 $199
3 $60,601 to $73,480 $249
3 $73,481 to $86,360 $299
3 $86,361 + OneOme offers patient self-pay ($349)
4 $0 to $26,500 $49
4 $26,501 to $39,380 $99
4 $39,381 to $52,260 $149
4 $52,261 to $65,140 $199
4 $65,141 to $78,020 $249
4 $78,021 to $90,900 $299
4 $90,901 + OneOme offers patient self-pay ($349)

Insurance billing process

  • OneOme reviews the patient’s insurance information to make sure it is complete and accurate.
  • OneOme will pre-qualify the patient for financial assistance.
    • Patients eligible for financial assistance: The FAP-qualified amount is the maximum out of pocket cost the patient can expect regardless of whether their insurance will contribute to the cost of the test. If OneOme opts to bill a patient’s insurance, they may receive a bill for the patient responsibility up to the FAP-qualified amount once insurance billing is completed. If a patient’s insurance is unlikely to cover the test, we will contact the patient and request payment at the FAP-qualified amount up front.
    • Patients ineligible for financial assistance: The patient self pay rate will likely be the lowest cost option, regardless of insurance contribution. OneOme will contact the patient to offer our self pay option.
  • If OneOme determines that the patient qualifies for FAP, OneOme submits the insurance claim directly to the insurance company once the test results are ready.
  • If a claim is submitted, the patient will receive an explanation of benefits (EOB) from their insurance company in the mail. The EOB is NOT a bill, but an explanation of what was covered.
  • If coverage is denied or only part of the test is covered, OneOme may appeal the decision on behalf of the patient.
  • After a final coverage decision from insurance is made, a patient may receive an invoice from OneOme for any deductibles, coinsurance, copayments, and for services deemed non-covered or ineligible under their insurance policy. When applicable OneOme will reduce this remaining balance up to their FAP-qualified price.

Billing codes

It is the responsibility of the submitting party to determine the correct billing codes to use when filing billing claims to third-party insurance. Below is a list of relevant codes.

Gene CPT code CPT code description
CYP1A2 81479 Unlisted molecular pathology procedure
CYP2B6 81479 Unlisted molecular pathology procedure
CYP2C19 81225 Cyp2c19 gene common variants
CYP2C9 81227 Cyp2c9 gene common variants
CYP2D6 81226 Cyp2d6 gene common variants
CYP3A4 81230 Cyp3a4 gene common variants
CYP3A5 81231 Cyp3a5 gene common variants
SLCO1B1 81328 Slco1b1 gene common variants
UGT1A1 81350 Ugt1a1 gene
VKORC1 81355 Vkorc1 gene
F2 81240 F2 gene
NUDT15 81479 Unlisted molecular pathology procedure
F5 81241 F5 gene
OPRM1 81479 Unlisted molecular pathology procedure
COMT 81479 Unlisted molecular pathology procedure
DRD2 81479 Unlisted molecular pathology procedure
HTR2C 81479 Unlisted molecular pathology procedure
HTR2A 81479 Unlisted molecular pathology procedure
DPYD 81232 Dpyd gene common variants
GRIK4 81479 Unlisted molecular pathology procedure
IL28B (IFNL4) 81283 Ifnl4 gene
TPMT 81335 Tpmt gene common variants
SLC6A4 81479 Unlisted molecular pathology procedure
CYP2C Cluster 81479 Unlisted molecular pathology procedure
CYP4F2 81479 Unlisted molecular pathology procedure
HLAA 81381 Hla i typing 1 allele hr
HLAB 81381 Hla i typing 1 allele hr
MTHFR 81291 Mthfr gene com variants

OneOme’s tests were developed and their performance characteristics have been determined by OneOme, LLC, a clinical laboratory located at 807 Broadway Street NE, Suite 100 Minneapolis, MN 55413. They have not been cleared or approved by the U.S. Food and Drug Administration. OneOme is regulated under CLIA-88 as qualified to perform high-complexity testing. These tests are used for clinical purposes and should not be regarded as investigational or for research.

Have questions about billing?

Dedicated experts are available to answer your questions. Speak with a client service representative today.