Billing information

OneOme’s mission is to provide the most cost-effective, pharmacogenomic testing and tools for providers across the globe to use in everyday patient care. In order to achieve this goal, we offer multiple billing options.

Billing options

At OneOme, our goal is to provide every patient with access to pharmacogenomic testing. That’s why we’ve created a billing process that supports different payment options, depending on how the test is ordered, including:

Our client services team is available to work with you to find the best billing option for your scenario. CONTACT US for more information or review our billing FAQs.

Patient self-pay

For tests ordered by a patient’s provider, patients may pay for the test directly at the time the provider submits the order, or OneOme can contact the patient to collect payment after the provider submits the order. OneOme accepts payments from all major credit cards, HSA accounts, and PayPal. In addition, we offer interest-free payment plans when needed. Please CONTACT US for more information about interest-free payment plans.

Please note that the 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, HSA accounts, and PayPal (insurance billing is not available for this option).

Institutional billing

We can bill institutions directly at our current list price without a contract. Discounted pricing is available with a contract. 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

OneOme accepts all insurance plans.

Private insurance
For tests ordered by a patient’s provider, OneOme will work with a patient’s private insurance company to determine coverage and payment. Our goal is for patients to access the lowest cost available. If the patient’s out-of-pocket cost is likely to exceed $249, OneOme will reach out to the patient to offer alternative options.

If a patient has a balance, they can pay by check, credit card, or HSA, and will also have the option to establish an interest free payment plan. OneOme’s client services team will ensure that the patient understands the process and that they are effectively communicated with along the way.

OneOme Financial Assistance Program (FAP)
OneOme offers financial assistance to reduce out-of-pocket costs for qualified patients in the U.S. to no more than $249. To be eligible, patients must have private insurance, and meet low income requirements (household incomes up to 400 percent of the Federal poverty guidelines).

Process

  • OneOme reviews the patient’s insurance information to make sure it is complete and accurate.
  • OneOme will confirm insurance requirements and determine the estimated out-of-pocket costs for the patient.
  • OneOme will contact the patient if the patient’s estimated out-of-pocket cost exceeds the self-pay price to offer them alternative payment options.
  • OneOme sends an informational letter to the patient describing the process and what to expect.
  • OneOme submits the insurance claim directly to patient’s insurance company, once the order is processed.
  • Patient receives 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 will appeal the decision on behalf of the patient.
  • After a final coverage decision from insurance, a patient may receive an invoice from OneOme for any deductibles, co-insurance, co-payments, and for services deemed non-covered or ineligible under their insurance policy.

Medicare and Medicaid
OneOme accepts all Medicare and Medicaid plans. For traditional Medicare/Medicaid or Managed Medicaid Plans a patient’s out-of-pocket cost will be $0. Medicare Advantage Plans may have a co-payment or deductible requirement.

For traditional Medicare claims, we require a signed letter of medical necessity.

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 Mopath procedure level 2
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.