openapi: 3.0.1
info:
title: CMS Common Facility
description: MicroService that contains CMS related information
contact:
name: Ken Kracker
email: ken.kracker@optum.com
version: v1.0
servers:
- url: /v1/cmscommonms
paths:
/api/cms/facility/supporting-documents/:
post:
tags:
- Supporting Documentation APIs
summary: Fetches lists of data for supporting documentation
operationId: getSupportingDocumentationDetails
parameters:
- name: sort
in: query
description: Any of these values (publicationType,-publicationType, postDate,-postDate,effectiveDate,-effectiveDate)
are allowed. The default is -postDate
required: false
schema:
type: array
items:
type: string
default:
- -postDate
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
requestBody:
description: Supporting documentation search request
content:
application/json:
schema:
$ref: '#/components/schemas/SupportingDocument'
examples:
Supporting Documentation Search Request:
description: Supporting Documentation Search Request
value:
publicationType: ''
fileName: ''
publicationSubject: ''
postDate: ''
effectiveDate: ''
required: true
responses:
'200':
description: Post-for-GET - Fetch list of supporting documentation
content:
application/json:
example:
content:
- docId: 2389
publicationType: MLN MATTERS
fileName: MM7134
heading: Fiscal Year (FY) 2011 Inpatient Prospective Payment System (IPPS), Long Term
Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes
postDate: '2010-10-01 00:00:00'
effectiveDate: '2010-10-01 00:00:00'
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-05-18T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /api/cms/facility/supporting-documents
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-05-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/supporting-documents/
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/transmittal/:
post:
tags:
- CMS Transmittal APIs
summary: Fetches the data for CMS Transmittal
operationId: getCMSTransmittal
parameters:
- name: sort
in: query
description: Any of these values(publicationType,-publicationType,publicationSubject,-publicationSubject,transmittalNumber,-transmittalNumber,changeRequest,-changeRequest,postDate,-postDate,effectiveDate,-effectiveDate,docImpDate,-docImpDate,rescinded,-rescinded,replacedBy,-replacedBy,relatedDocName,-relatedDocName,retroactiveFlag,-retroactiveFlag,healthCareTypes,-healthCareTypes,specialities,-specialities
) are allowed.The default is -effectiveDate
required: false
schema:
type: array
items:
type: string
default: []
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/CMSTransmittal'
responses:
'200':
description: 'POST-for-GET: Fetch CMS Transmittal '
content:
application/json:
example:
content:
- docId: 615315
documentSourceId: 4
publicationType: Pub 100-04 Medicare Claims Processing
publicationSubject: Annual Updates to the Prior Authorization/Pre-Claim Review Federal
Holiday Schedule Tables for Generating Reports
transmittalNumber: R12026CP
changeRequest: '13151'
postDate: '2023-05-11 00:00:00'
effectiveDate: '2024-01-01 00:00:00'
docImpDate: '2023-10-02 00:00:00'
healthCareTypes: ALL TYPES
specialities: ALL PROVIDERS
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/transmittalssss
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/transmittal
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/policy-lookup/:
post:
tags:
- Policy Lookup APIs
summary: Fetches all the policies of a given policy type and given code and/or term
operationId: searchPolicyLookup
parameters:
- name: sort
in: query
description: Any of these (contractorType,-contractorType,serviceAreas,-serviceAreas) are allowed
values, default is -contractorType
required: false
schema:
type: array
items:
type: string
default:
- contractorType
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
requestBody:
content:
application/json:
schema:
$ref: '#/components/schemas/PolicySearchRequest'
responses:
'200':
description: 'POST-for-GET - Search Policy Lookup '
content:
application/json:
example:
content:
- icpContractorId: 176
icpPolicyId: 535110
determinationNum: A59355
contractorType: MA
contractorName: CGS Administrators, LLC
policyType: LCD
cms: A59355
policyTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
effectiveDate: '2023-06-29'
url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59355&ver=6&bc=0
serviceAreas: KY
contractorNum: '15101'
hasArticles: '0'
displayName: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
scrubbedTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
contractorServiceAreas: 15101 - CGS Administrators, LLC (KY)
contractorTypeDisplayName: Part A - FI
- icpContractorId: 177
icpPolicyId: 535111
determinationNum: A59355
contractorType: MA
contractorName: CGS Administrators, LLC
policyType: LCD
cms: A59355
policyTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
effectiveDate: '2023-06-29'
url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59355&ver=6&bc=0
serviceAreas: OH
contractorNum: '15201'
hasArticles: '0'
displayName: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
scrubbedTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
contractorServiceAreas: 15201 - CGS Administrators, LLC (OH)
contractorTypeDisplayName: Part A - FI
totalCount: 2
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/policy-lookuppp
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/policy-lookup
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/app/cms/common/policy-lookup/{policy-id}/related-articles:
get:
tags:
- Policy Lookup APIs
summary: Fetches LCD related articles of a given LCD policy id
operationId: fetchRelatedLCDPolicyByPolicyById
parameters:
- name: policy-id
in: path
description: Policy Id
required: true
schema:
type: string
example: 497873
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
type: array
items:
$ref: '#/components/schemas/PolicyValue'
security:
- bearerAuth: []
/app/cms/common/cci/modifiers/{code}:
get:
tags:
- CCI Edits APIs
summary: Fetches modifiers based on given code
operationId: fetchRelatedLCDPolicyByPolicyById_1
parameters:
- name: code
in: path
description: Code
required: true
schema:
type: string
example: 99213
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
$ref: '#/components/schemas/OptumPageImplModifiersPopUpValue'
security:
- bearerAuth: []
/app/cms/common/cci/codeValidator:
get:
tags:
- CCI Edits Code Validator API
summary: Returns list of valid codes from a string of comma separated codes
operationId: fetchValidCodes
parameters:
- name: codes
in: query
description: Takes comma separated codes with minimum of 1 code and maximum of 36 codes
required: true
schema:
type: string
example: 99213,99214
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
type: array
items:
type: string
security:
- bearerAuth: []
/api/cms/{mueType}/mue:
get:
tags:
- Medically Unlikely Edits(MUEs) APIs
summary: Fetches the Medically Unlikely Edits table data for MUE Physician OR Facility
operationId: getMueTableData
parameters:
- name: mueType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these values (code, -code )are allowed.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MUE list
content:
application/json:
example:
content:
- code: 0001A
unit: '1'
mueAdjIndicator: '2 Date of Service Edit: Policy'
mueRationale: Code Descriptor / CPT Instruction
- code: 0001U
unit: '1'
mueAdjIndicator: '2 Date of Service Edit: Policy'
mueRationale: Code Descriptor / CPT Instruction
totalCount: 2
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-12-2T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/mue
security:
- bearerAuth: []
/api/cms/{iomType}/iom-policy/{codeType}/{code}:
get:
tags:
- CMS IOM's Policy APIs
summary: 'Fetches CMS IOM policies '
operationId: getCMSIOMSPolicies
parameters:
- name: codeType
in: path
required: true
schema:
type: string
enum:
- cpt
- hcpcs
- name: iomType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: code
in: path
required: true
schema:
type: string
example: 90740
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: 'Fetches CMS IOM policies '
content:
application/json:
example:
content:
- policyId: '11546543'
policyName: 100-04,18,10.2.1
policyText: Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes
Vaccines
and their administration are reported using separate codes. The following codes are
for reporting the vaccines only.
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-10-20T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/iom-policy/invalid
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-20T06:37:03.741+00:00'
path: /cmscommonms/api/cms/iom-policy
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/{cmsType}/policy-list/ncd/{contractorPart}/{codetype}/{code}:
get:
tags:
- Medicare Coverage Policy for part A and Part B APIs
summary: Fetches NCD Policies for particular Contractor part and Code (procedural or diagnosis)
operationId: getNCDPolicyList
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- hcpcs
- i9v3
- cpt
- i9v1
- i10_pcs
- i10_cm
- name: code
in: path
required: true
schema:
type: string
example: A4575
- name: cmsType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: contractorPart
in: path
required: true
schema:
type: string
enum:
- DME
- B
- A
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches NCD policies for particular contractor part and code (procedural or diagnosis)
content:
application/json:
example:
content:
- icpContractorId: 0
icpPolicyId: 274765
determinationNum: 240.2.1
policyType: NCD
cms: 240.2.1
policyTitle: NCD for Home Use of Oxygen in Approved Clinical Trials (240.2.1)
effectiveDate: '2006-03-20'
url: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=312&ncdver=1&DocID=240.2.1&bc=gAAAAAgAAAAAAA%3d%3d&
hasArticles: '0'
displayName: 'Home Use of Oxygen in Approved Clinical Trials '
totalCount: 1
'400':
description: 'Bad request: some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '992133' in this web service request is not a valid 'cpt' code.
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/physician/policy-list/NCD/C/HCPCS/A4575
security:
- bearerAuth: []
/api/cms/{cmsType}/policy-list/lcd/{contractorPart}/{codetype}/{code}:
get:
tags:
- Medicare Coverage Policy for part A and Part B APIs
summary: Fetches LCD policies for particular contractor Id , contractor part and code (procedural
or diagnosis)
operationId: getLCDPolicyList
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- hcpcs
- i9v3
- cpt
- i9v1
- i10_pcs
- i10_cm
- name: code
in: path
required: true
schema:
type: string
example: A4575
- name: cmsType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: contractorPart
in: path
required: true
schema:
type: string
enum:
- A
- B
- DME
- name: sort
in: query
description: Any of these (serviceAreas,-serviceAreas) are allowed values, default is serviceAreas
required: false
schema:
type: array
items:
type: string
default:
- serviceAreas
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: contractor-id
in: query
required: false
schema:
type: integer
format: int32
example: 128
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches LCD policies for particular contractor id , contractor part and code (procedural
or diagnosis)
content:
application/json:
example:
content:
- icpContractorId: 128
icpPolicyId: 528715
determinationNum: L37873
contractorType: MA
contractorName: Palmetto GBA
policyType: LCD
cms: L37873
policyTitle: Topical Oxygen Therapy
effectiveDate: '2019-05-06'
url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37873&ver=14&bc=0
serviceAreas: SC
contractorNum: '11201'
hasArticles: '2'
totalCount: 1
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/policy-list/LCD/C/HCPCS/A4575?contractor_id=128
security:
- bearerAuth: []
/api/cms/facility/{procedure-device-type}:
get:
tags:
- Device Codes APIs
summary: Fetches the device to procedure/procedure to device codes and their descriptions
operationId: getProcedureToDeviceToProcedureCodes
parameters:
- name: procedure-device-type
in: path
required: true
schema:
type: string
enum:
- device-to-procedure
- procedure-to-device
- name: sort
in: query
description: Any of these values (code,-code) are allowed.The default is -code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: 'Fetches device to procedure/procedure to device codes list '
content:
application/json:
example:
content:
- code: C1721
codeDescription: Cardioverter-defibrillator, dual chamber (implantable)
- code: C1722
codeDescription: Cardioverter-defibrillator, single chamber (implantable)
totalCount: 2
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-05T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/device-to-procedure-invalid
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-05T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/facility/device-to-procedure
security:
- bearerAuth: []
/api/cms/facility/{procedure-device-type}/{device-or-procedure-code}:
get:
tags:
- Device Codes APIs
summary: Fetches device to procedure/procedure to device codes and their descriptions for a specific
device or procedure code
operationId: getProcedureToDeviceToProcedureCodeSpecific
parameters:
- name: procedure-device-type
in: path
required: true
schema:
type: string
enum:
- device-to-procedure
- procedure-to-device
- name: device-or-procedure-code
in: path
required: true
schema:
type: string
example: C1721
- name: sort
in: query
description: Any of these values (code,-code) are allowed.The default is -code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches device to procedure/procedure to device codes list for a specific device
or procedure code
content:
application/json:
example:
content:
- code: '33224'
codeDescription: Insertion of pacing electrode, cardiac venous system, for left ventricular
pacing, with attachment to previously placed pacemaker or implantable defibrillator
pulse generator (including revision of pocket, removal, insertion, and/or replacement
of existing generator)
- code: '33230'
codeDescription: Insertion of implantable defibrillator pulse generator only; with existing
dual leads
totalCount: 2
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-05T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/device-to-procedure-invalid/C1721
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-05T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/facility/device-to-procedure/C1721
security:
- bearerAuth: []
/api/cms/facility/{device-type}:
get:
tags:
- Device Codes APIs
summary: Facility - fetch all device codes or device dependent procedure codes
operationId: fetchDeviceCodes
parameters:
- name: device-type
in: path
required: true
schema:
type: string
enum:
- device-codes
- device-dependent-procedure-codes
- name: sort
in: query
description: Any of these values(code, -code, opsi, -opsi, apc, -apc) are allowed.The default
is code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches the device codes or device dependent procedure codes
content:
application/json:
example: " \"content\": [\n {\n \"code\": \"A4648\",\n \"description\"\
: \"Tissue marker, implantable, any type, each\",\n \"opsi\": \"N\"\n \
\ },\n {\n \"code\": \"C1052\",\n \"description\": \"Hemostatic\
\ agent, gastrointestinal, topical\",\n \"opsi\": \"N\"\n },\n \
\ {\n \"code\": \"C1062\",\n \"description\": \"Intravertebral body\
\ fracture augmentation with implant (e.g., metal, polymer)\",\n \"opsi\": \"\
N\"\n }\n ]\n"
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code, opsi, apc]
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than zero'
path: /cmscommonms/api/cms/facility/device-codes
security:
- bearerAuth: []
/api/cms/facility/{codetype}/mce-edits:
get:
tags:
- MCE Edits ICD9 and ICD10 API
summary: Fetches MCE Edits data
operationId: fetchMCEEdits
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- icd9
- icd10
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is -code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MCE edits data
content:
application/json:
example:
content:
- code: '3'
description: DUPLICATE OF PRINCIPAL DIAGNOSIS
definition: Any secondary diagnosis that is the same code as the principal diagnosis
is identified as a duplicate because the secondary code may cause an erroneous assignment
to an MS-DRG with complications. The contractor will delete the duplicate secondary
diagnosis and process the bill.
- code: '4'
description: AGE CONFLICT
definition: This edit identifies inconsistencies between a patient's age and any diagnosis
on the patient's record. The diagnosis is considered clinically impossible for a
patient in the stated age. Either the diagnosis or the age is considered inaccurate. The
contractor will return the claim for correction of this error.
associatedCodeLink:
value: '4'
href: /api/cms/facility/mce/associated-icd9/4
totalCount: 19
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-12T13:52:54.478+00:00'
status: 404
error: Not Found
trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource
api/cms/facility/mce-edits.'
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-12T13:38:46.141+00:00'
status: 500
error: Internal Server Error
path: cmscommonms/api/cms/facility/icd10/mce-edits?limit=50&page=1
message: 'java.lang.IllegalArgumentException: Page size must not be less than one'
security:
- bearerAuth: []
/api/cms/facility/{codetype}/{code}/drgs:
get:
tags:
- DRG Information APIs
summary: Fetches the DRG codes for given icd code
operationId: drgCodesForIcdCode
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i9v1
- i9v3
- i10_cm
- i10_pcs
example: i10_cm
- name: code
in: path
required: true
schema:
type: string
example: I60.00
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: sort
in: query
description: Any of these (drgCode,-drgCode) are allowed values.
required: false
schema:
type: array
items:
type: string
default:
- drgCode
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MCE edits data
content:
application/json:
example:
content:
- drgCode: '020'
fullDescription: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage
with MCC
mdc: '1'
mdcDescription: Diseases And Disorders Of The Nervous System
medSurg: S
gmLos: '10.2'
amLos: '14.1'
relativeWeight: '8.4524'
nationalPayment: '54042.79'
- drgCode: '021'
fullDescription: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage
with CC
mdc: '1'
mdcDescription: Diseases And Disorders Of The Nervous System
medSurg: S
gmLos: '6.3'
amLos: '9.0'
relativeWeight: '6.1414'
nationalPayment: '39266.76'
- drgCode: '022'
fullDescription: Intracranial Vascular Procedures with Principal Diagnosis of Hemorrhage
without CC/MCC
mdc: '1'
mdcDescription: Diseases And Disorders Of The Nervous System
medSurg: S
gmLos: '2.5'
amLos: '3.9'
relativeWeight: '3.4767'
nationalPayment: '22229.25'
totalCount: 3
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-12T13:52:54.478+00:00'
status: 404
error: Not Found
trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource
api/cms/cms/facility/cpt/99213/drgs.'
security:
- bearerAuth: []
/api/cms/facility/{codetype}/{code}/{conditiontype}/cc-mcc:
get:
tags:
- CC/MCC Code and Excludes List for I10CM and I9V1 APIs
summary: Fetches the CC MCC codes excludes table data for I10CM and I9V1 codetype
operationId: getCCMCCCodeExcludesList
parameters:
- name: codetype
in: path
required: true
schema:
type: string
description: codetypes
enum:
- i9v1
- i10_cm
- name: code
in: path
required: true
schema:
type: string
description: code
- name: conditiontype
in: path
required: true
schema:
type: string
description: conditiontype
enum:
- '1'
- '2'
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch code, codeDescription and details.
content:
application/json:
example:
content:
- code: '011.00'
description: Tuberculosis of lung, infiltrative, confirmation unspecified
- code: '011.01'
description: Tuberculosis of lung, infiltrative, bacteriological or histological examination
not done
- code: '011.02'
description: Tuberculosis of lung, infiltrative, bacteriological or histological examination
unknown (at present)
- code: '011.03'
description: Tuberculosis of lung, infiltrative, tubercle bacilli found (in sputum)
by microscopy
- code: '011.04'
description: Tuberculosis of lung, infiltrative, tubercle bacilli not found (in sputum)
by microscopy, but found by bacterial culture
- code: '011.05'
description: Tuberculosis of lung, infiltrative, tubercle bacilli not found by bacteriological
examination, but tuberculosis confirmed histologically
- code: '011.06'
description: Tuberculosis of lung, infiltrative, tubercle bacilli not found bacteriological
or histological examination, but tuberculosis confirmed by other methods (inoculation
of animals)
totalCount: 7
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-09-10T09:19:11.084+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page index must
not be less than zero'
path: /cmscommonms/api/cms/facility/i9v1/011.04/1/cc-mcc
security:
- bearerAuth: []
/api/cms/facility/{codetype}/cc-mcc/code-list:
get:
tags:
- CC/MCC Code and Excludes List for I10CM and I9V1 APIs
summary: Fetches the CC MCC codes table data for I10CM and I9V1 codetype
operationId: getCCMCCCodeList
parameters:
- name: codetype
in: path
required: true
schema:
type: string
description: codetypes
enum:
- i9v1
- i10_cm
- name: conditiontype
in: query
required: false
schema:
type: string
description: conditiontype
enum:
- '1'
- '2'
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these values (code,-code) are allowed.The default is code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch code, codeDescription and details.
content:
application/json:
example:
content:
- code: '001.0'
description: Cholera due to Vibrio cholerae
conditionType: '1'
excludeCodes: 001.0-001.9
- code: '001.1'
description: Cholera due to Vibrio cholerae el tor
conditionType: '1'
excludeCodes: 001.0-001.9
- code: '001.9'
description: Unspecified cholera
conditionType: '1'
excludeCodes: 001.0-001.9
totalCount: 3
'400':
description: Bad request
content:
application/json:
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-09-10T09:19:11.084+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page index must
not be less than zero'
path: /cmscommonms/api/cms/facility/i9v1/cc-mcc/code-list
security:
- bearerAuth: []
/api/cms/facility/{codeType}/diagnosis/{code}/ioce-edits:
get:
tags:
- I-OCE Edits APIs
summary: Facility - Fetch I-OCE associated with diagnosis i10cm/i9v1 code
operationId: getIOCEAssociatedForICD10CmI9V1Code
parameters:
- name: codeType
in: path
required: true
schema:
type: string
enum:
- i10_cm
- i9v1
- name: code
in: path
required: true
schema:
type: string
example: A18.14
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - Detail associated with diagnosis i10cm/i9v1 code
content:
application/json:
example:
loAge: 15
hiAge: 124
validSex: 0
mspAlert: null
ecode: 0
ismentalhealthdx: 0
ismalignancy: null
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/{codeType:i10_cm|i9v1}/diagnosis/{code}/ioce-edits/invalid
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/{codeType:i10_cm|i9v1}/diagnosis/{code}/ioce-edit
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/{codeType}/procedure/{code}/ioce-edits:
get:
tags:
- I-OCE Edits APIs
summary: Facility - Fetch I-OCE associated with specified cpt hcpcs code
operationId: getIOCEAssociatedForCptHcpcsCode
parameters:
- name: codeType
in: path
required: true
schema:
type: string
enum:
- cpt
- hcpcs
- name: code
in: path
required: true
schema:
type: string
example: 11920
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - detail associated with specified I-OCE cpt/hcpcs codecode
content:
application/json:
example:
code: '15832'
apc: '5073'
statusIndicator:
code: J1
description: Hospital Part B services paid through a comprehensive APC
paymentIndicator:
id: 1
description: Paid standard hospital OPPS amount (status indicators J1, J2, R, S, T,
U, V, X)
oceMap:
code: '12'
description: Questionable covered service
editResult: "This edit occurs when the procedure code reported has a questionable covered\
\ service indicator. It identifies procedures that are only covered by the Medicare\
\ program under certain medical circumstances.\nEXAMPLES:\n 5833 Exc Lipectomy Leg\
\ is covered by Medicare only when medically necessary.\n 36469 Injection Spider Veins\
\ Face is covered by Medicare only when medically necessary.\n\nThe claim will be\
\ suspended."
provideAction: A suspended claim is not returned to the provider but will not be processed
for payment until the FI makes a determination or obtains further information.
deductibleNA: false
maxUnitsAllowed: null
condBilateral: false
inBilateral: false
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/{codeType:cpt|hcpcs}/procedure/{code}/ioce-edits/invalid
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/{codeType:cpt|hcpcs}/procedure/{code}/ioce-edit
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/{apctype}:
get:
tags:
- APC Cross Codes APIs
summary: Facility - fetches APC cross codes
operationId: fetchAPCCrossCodes
parameters:
- name: apctype
in: path
required: true
schema:
type: string
enum:
- apc
- composite-apc
- comprehensive-apc
- name: sort
in: query
description: Any of these values (apc,-apc) are allowed.The default is apc
required: false
schema:
type: array
items:
type: string
default:
- apc
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches APC Cross Codes
content:
application/json:
example:
content:
- apc: '0701'
description: Sr89 strontium
- apc: '0702'
description: Inj, human-lans, per i.u
- apc: '0703'
description: Inj daxibotulinumtoxina-lanm
totalCount: 915
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than zero'
path: /cmscommonms/api/cms/facility/apc
security:
- bearerAuth: []
/api/cms/facility/{apctype}/{code}:
get:
tags:
- APC Cross Codes APIs
summary: Facility - Fetches CPT/HCPCS Code Specific APC Cross Codes
operationId: fetchCodeSpecificAPCCrossCodes
parameters:
- name: apctype
in: path
required: true
schema:
type: string
enum:
- apc
- composite-apc
- comprehensive-apc
- name: code
in: path
required: true
schema:
type: string
example: 71045
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches CPT/HCPCS Code Specific APC Cross Codes
content:
application/json:
example:
content:
- apc: '5521'
description: Level 1 Imaging without Contrast
totalCount: 1
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2024-05-16T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than zero'
path: /cmscommonms/api/cms/facility/apc
security:
- bearerAuth: []
/api/cms/facility/{apcCode}/apc-cross-codes:
get:
tags:
- APC Cross Codes APIs
summary: Facility - Fetches APC Cross Codes of given Apc Code
operationId: fetchAPCCrossCodeDetail
parameters:
- name: apcCode
in: path
required: true
schema:
type: string
example: 5191
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches APC Cross Codes of given Apc Code
content:
application/json:
example: " {\n \"content\": [\n {\n \"code\": \"93451\"\
,\n \"opsiCode\": \"J1\",\n \"apc\": \"5191\",\n \"\
description\": \"RIGHT HEART CATH\",\n \"payRate\": \"3104.73\",\n \
\ \"natUnadjCopay\": \"863.75\",\n \"minUnadjCopay\": \"620.95\",\n \
\ \"relWeight\": \"35.5305\"\n },\n {\n \"\
code\": \"93452\",\n \"opsiCode\": \"J1\",\n \"apc\": \"5191\"\
,\n \"description\": \"LEFT HRT CATH W/VENTRCLGRPHY\",\n \"payRate\"\
: \"3104.73\",\n \"natUnadjCopay\": \"863.75\",\n \"minUnadjCopay\"\
: \"620.95\",\n \"relWeight\": \"35.5305\"\n },\n {\n\
\ \"code\": \"93453\",\n \"opsiCode\": \"J1\",\n \"\
apc\": \"5191\",\n \"description\": \"R&L HRT CATH W/VENTRICLGRPHY\",\n \
\ \"payRate\": \"3104.73\",\n \"natUnadjCopay\": \"863.75\",\n \
\ \"minUnadjCopay\": \"620.95\",\n \"relWeight\": \"35.5305\"\n\
\ },\n ],\n \"totalCount\": 915\n }\n"
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than zero'
path: /cmscommonms/api/cms/facility/apcCrossCodes/code
security:
- bearerAuth: []
/api/cms/facility/tob-oce:
get:
tags:
- Type of Bill I/OCE Edit OPPS
summary: Fetches the type of bill I/OCE edit
operationId: getTobOce
parameters:
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 250
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch the type of bill I/OCE Edit OPPS details
content:
application/json:
example:
content:
- code: '1'
description: TOB 012X or 014X with condition code 41 reported in FLs 18-28
- code: '2'
description: TOB 012X or 014X without condition code 41
totalCount: 19
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-24T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/tob-oce
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/tob-oce/{code}:
get:
tags:
- Type of Bill I/OCE Edit OPPS
summary: Fetches the specifics bill type of bill I/OCE edit
operationId: getTobOceByCode
parameters:
- name: code
in: path
description: Code of the TOB OCE
required: true
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch the type of bill I/OCE edit OPPS details
content:
application/json:
example:
- description: Line Item Date Edit
oceValueList:
- code: '10'
description: Service submitted for denial (condition code [UB-4 FL 18-28] 21)
editResult: "This edit occurs when the claim has a condition code 21, Request for Denial\
\ Notification, reported in FLs 18-28. It identifies services that are billed\
\ by a provider for a denial notice. \n\nThe claim will be denied."
providerAction: 'The provider cannot correct and resubmit the claim but they can appeal
the denial. '
- code: '23'
description: Invalid date
editResult: "This edit occurs when the from and through statement covers dates (FL 6)\
\ or the service date (FL 45) are invalid or the service date falls outside the from\
\ and through dates. This edit terminates the processing of the claim. \n\nReturn\
\ claim to provider (RTP)."
providerAction: The provider should resubmit the claim once the problem(s) is/are corrected.
- code: '24'
description: Date out of OCE range
editResult: "This edit occurs when the \"from\" date reported in the statement covers\
\ period, FL 6 falls outside the date range for any version of the OCE program (before\
\ August 1, 2000). This edit terminates the processing of the claim. \n\nThe claim\
\ will be suspended."
providerAction: A suspended claim is not returned to the provider but will not be processed
for payment until the FI makes a determination or obtains further information.
- code: '11'
description: Service submitted for FI/MAC review (condition code [UB-4 FL 18-28] 20)
editResult: 'This edit occurs when the claim has a condition code 20, Request for FI/MAC
Review, reported in FLs 18-28. It identifies non-covered services that are billed
by the provider when a beneficiary requests a Medicare review for coverage.
The claim will be suspended.'
providerAction: A suspended claim is not returned to the provider but will not be processed
for payment until the FI makes a determination or obtains further information.
- description: Bill Type Edit
oceValueList:
- code: '46'
description: Partial hospitalization condition code 41 not approved for type of bill
editResult: "This edit identifies incorrect partial hospitalization claims and occurs\
\ when TOB code (FL 4) 12X or 14X is present on the claim with condition code 41 in\
\ FLs 18-28. \n\nReturn claim to provider (RTP)."
providerAction: The provider should resubmit the claim once the problem(s) is/are corrected.
'400':
description: 'Bad request: If any of the path parameters are invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- Type of Bill I/OCE Edit Code is not supported
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-24T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/tob-oce/111
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/supporting-documents/{doc-id}/document-download:
get:
tags:
- Supporting Documentation APIs
summary: Fetches the file content for supporting documentation
operationId: getSupportingDocumentPDF
parameters:
- name: doc-id
in: path
description: Supporting Document ID
required: true
schema:
type: integer
format: int32
example: 633266
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches The File Content in the form of byte array, response headers and media
type as FileType
content:
application/pdf:
schema:
$ref: '#/components/schemas/Notification'
example: " access-control-expose-headers: Content-Disposition\n cache-control: no-cache,no-store,max-age=0,must-revalidate\n\
\ connection: keep-alive\n content-disposition: attachment; filename=Removal of Outdated\
\ Regulations.pdf\n content-length: 254685\n content-type: application/pdf\n date:\
\ Thu,16 May 2024 06:49:56 GMT\n expires: 0\n pragma: no-cache\n vary: Origin,Access-Control-Request-Method,Access-Control-Request-Headers\n\
\ x-content-type-options: nosniff\n x-frame-options: DENY\n x-xss-protection: 0\n"
'404':
description: Not found- sub terms not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-28T06:19:48.666+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/supporting-documents/{docId}document-download
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:19:48.666+00:00'
path: /cmscommonms/api/cms/facility/supporting-documents/{docId}document-download
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/cms/facility/remittance-advice-remark-codes/:
get:
tags:
- Remittance Advice Remark Codes APIs
summary: Fetches the remittance advice remark codes for facility
operationId: getRemittanceAdviceCodes
parameters:
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these (code, -code )are allowed values.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch complete list of remittance advice remark codes
content:
application/json:
example:
content:
- code: M1
codeDescription: 'X-ray not taken within the past 12 months or near enough to the start
of treatment. Note: New as of: 01/01/1997'
- code: M10
codeDescription: 'Equipment purchases are limited to the first or the tenth month of
medical necessity. Note: New as of: 01/01/1997'
- code: M100
codeDescription: 'We do not pay for an oral anti-emetic drug that is not administered
for use immediately before, at, or within 48 hours of administration of a covered
chemotherapy drug. Note: New as of: 01/01/1997'
totalCount: 9
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
security:
- bearerAuth: []
/api/cms/facility/mpfs/payment/{carrier}/{locality}:
get:
tags:
- MPFS National Payment Table Facility APIs
summary: Fetch MPFS facility national payment
operationId: getMPFSFacilityPayment
parameters:
- name: carrier
in: path
description: Carrier value
required: true
schema:
type: string
example: 10112
- name: locality
in: path
description: Locality value
required: true
schema:
type: string
example: '00'
- name: sort
in: query
description: Any of these (code,-code ,modifier ,-modifier ,payment ,-payment ) are allowed values,
default is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MPFS facility payments
content:
application/json:
example:
content:
- code: 0446T
codeDescription: Creation of subcutaneous pocket with insertion of implantable interstitial
glucose sensor, including system activation and patient training
payment: '53.79'
- code: 0447T
codeDescription: Removal of implantable interstitial glucose sensor from subcutaneous
pocket via incision
payment: '63.21'
- code: 0448T
codeDescription: Removal of implantable interstitial glucose sensor with creation of
subcutaneous pocket at different anatomic site and insertion of new implantable sensor,
including system activation
payment: '90.13'
- code: '19296'
codeDescription: Placement of radiotherapy afterloading expandable catheter (single
or multichannel) into the breast for interstitial radioelement application following
partial mastectomy, includes imaging guidance; on date separate from partial mastectomy
payment: '197.09'
totalCount: 4
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'getMPFSFacilityPayment.carrier: Invalid Carrier value. Length should be 5'
- 'getMPFSFacilityPayment.locality: Invalid Locality value. Length should be 2'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/mpfs/facility-payment/10112/00
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/mdc/{codetype}/{mdccode}/drg:
get:
tags:
- DRG Information APIs
summary: Fetches DRG codes for the given MDC code for icd10 or icd9 codetype
operationId: fetchDRGCodeListForMDC
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- icd9
- icd10
- name: mdccode
in: path
required: true
schema:
type: string
example: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MDC Data for icd9 and icd10
content:
application/json:
example:
content:
- drgCode: '927'
fullDescription: Extensive Burns or Full Thickness Burns with Mechanical Ventilation
96+ Hours with Skin Graft
relativeWeight: '15.5499'
- drgCode: '928'
fullDescription: Full Thickness Burn with Skin Graft or Inhalation Injury with CC/MCC
relativeWeight: '5.3820'
- drgCode: '929'
fullDescription: Full Thickness Burn with Skin Graft or Inhalation Injury without CC/MCC
relativeWeight: '2.3344'
- drgCode: '933'
fullDescription: Extensive Burns or Full Thickness Burns with Mechanical Ventilation
96+ Hours without Skin Graft
relativeWeight: '2.7557'
- drgCode: '934'
fullDescription: Full Thickness Burn without Skin Graft or Inhalation Injury
relativeWeight: '1.5748'
- drgCode: '935'
fullDescription: Nonextensive Burns
relativeWeight: '1.4717'
totalCount: 6
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-05-16T07:02:57.183+00:00'
status: 404
error: Not Found
trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource
api/cms/facility/mdc/cpt/1/drg.'
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-05-16T07:15:00.252+00:00'
status: 500
error: Internal Server Error
path: cmscommonms/api/cms/facility/mdc/icd9/1/drg
message: 'java.lang.IllegalArgumentException: Page index must not be less than zero'
security:
- bearerAuth: []
/api/cms/facility/mdc/{codetype}/all:
get:
tags:
- DRG Information APIs
summary: Fetches MDC data for icd10 and icd9
operationId: fetchMCEEdits_1
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- icd9
- icd10
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MDC Data for icd9 and icd10
content:
application/json:
example:
content:
- code: '11'
fullDescription: Diseases And Disorders Of The Kidney And Urinary Tract
version: '41.1'
releaseDate: '2024-04-01 00:00:00'
totalCount: 1
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-05-09T07:02:57.183+00:00'
status: 404
error: Not Found
trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource
api/cms/facility/mdc/cpt/all.'
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-05-09T07:15:00.252+00:00'
status: 500
error: Internal Server Error
path: cmscommonms/api/cms/facility/mdc/icd10/all
message: 'java.lang.IllegalArgumentException: Page index must not be less than zero'
security:
- bearerAuth: []
/api/cms/facility/mce/associated-icd9/{id}:
get:
tags:
- MCE Associated ICD9 APIs
summary: Fetches MCE Associated ICD9 Codes
operationId: getMCEAssociatedICD9Codes
parameters:
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: id
in: path
required: true
schema:
type: integer
format: int32
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MCE associated ICD9 codes
content:
application/json:
example:
content:
- code: '040.41'
codeDescription: Infant botulism
details: 'Pediatric Age: 0-17 These diagnosis are intended for children and the patient''s
age must be between 0 and 17 years.'
- code: '058.10'
codeDescription: Roseola infantum, unspecified
details: 'Pediatric Age: 0-17 These diagnosis are intended for children and the patient''s
age must be between 0 and 17 years.'
totalCount: 3
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/mce/associated-icd91/4
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/mce/associated-icd9/4
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/mce-associated-icd10/parent/{mce_code}:
get:
tags:
- MCE Associated ICD10 APIs
summary: Fetches the mce associated codes table data for mce icd 10 parent code
operationId: getMCEAssociatedICD10ParentCode
parameters:
- name: dropdownValue
in: query
required: false
schema:
type: integer
format: int32
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: mce_code
in: path
required: true
schema:
type: integer
format: int32
- name: codetype
in: query
required: false
schema:
type: string
description: codetypes
enum:
- i10_pcs
- i10_cm
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch Code, codeDescription and details.
content:
application/json:
example:
content:
- code: A18.14
codeDescription: Tuberculosis of prostate
details: Male
- code: A18.15
codeDescription: Tuberculosis of other male genital organs
details: Male
- code: A18.16
codeDescription: Tuberculosis of cervix
details: Female
- code: A18.17
codeDescription: Tuberculous female pelvic inflammatory disease
details: Female
- code: A18.18
codeDescription: Tuberculosis of other female genital organs
details: Female
totalCount: 5
'400':
description: Bad request
content:
application/json:
example:
error:
- sort parameter value should be from list of [code, -code]
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-12T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: cmscommonms/api/cms/facility/mce-associated-icd10/parent/5?sort=code&limit=150&page=-1&filter=a18
security:
- bearerAuth: []
/api/cms/facility/mce-associated-icd10/dropdown/{id}:
get:
tags:
- MCE Associated ICD10 APIs
summary: Fetches the mce associated codes dropdown values for mce icd 10 code =4 and 5
operationId: getDropdownValues
parameters:
- name: id
in: path
required: true
schema:
type: integer
format: int32
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch Code and codeDescription
content:
application/json:
example:
- code: '1'
codeDescription: Adult 15-124 years
- code: '2'
codeDescription: Newborn 0 years
- code: '3'
codeDescription: Pediatric 0-17 years
- code: '4'
codeDescription: Maternity 9-64 years
'400':
description: Bad request
content:
application/json:
example:
error:
- Bad Request
message: Bad Request
path: /cmscommonms/api/cms/facility/mce-associated-icd10/dropdown/A
'404':
description: Not found
content:
application/json:
example:
error:
- Not Found
message: No static resource api/cms/facility/mce-associated-icd10/dropdow/4.
path: /cmscommonms/api/cms/facility/mce-associated-icd10/dropdow/4
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2024-04-12T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/mce-associated-icd10/dropdown/4
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/mce-associated-icd10/child/{conditionalId}:
get:
tags:
- MCE Associated ICD10 APIs
summary: Fetches the mce associated Codes table data for mce icd 10 child code
operationId: getMCEAssociatedICD10ChildCode
parameters:
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: conditionalId
in: path
required: true
schema:
type: integer
format: int32
- name: codetype
in: query
required: false
schema:
type: string
description: codetypes
enum:
- i10_pcs
- i10_cm
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch Code and codeDescription
content:
application/json:
example:
content:
- code: Z37.50
codeDescription: Multiple births, unspecified, all liveborn
- code: Z37.51
codeDescription: Triplets, all liveborn
- code: Z37.52
codeDescription: Quadruplets, all liveborn
- code: Z37.53
codeDescription: Quintuplets, all liveborn
- code: Z37.54
codeDescription: Sextuplets, all liveborn
- code: Z37.59
codeDescription: Other multiple births, all liveborn
totalCount: 6
'400':
description: Bad request
content:
application/json:
example:
error:
- sort parameter value should be from list of [code, -code]
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-12T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: cmscommonms/api/cms/facility/mce-associated-icd10/child/12?sort=code&limit=150&page=-1&filter=a18
security:
- bearerAuth: []
/api/cms/facility/ioce-edits:
get:
tags:
- I-OCE Edits APIs
summary: 'Facility - fetch I-OCE edits '
operationId: getIOCEEdits
parameters:
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - fetch I-OCE edits
content:
application/json:
example:
content:
- editNumber: '1'
editHospitalType: Both OPPS and non-OPPS edit
editDescription: Invalid diagnosis code
editResults: 'This edit occurs when the principal diagnosis field is blank, there are
no diagnoses listed, or the diagnosis code is not valid for the selected
version of the program. Each ICD-9-CM diagnosis code is edited for
completeness and validity. Codes without a required fourth or fifth
digit are considered invalid. Codes are also checked to insure that they
were valid at the time of the patient''s visit. Date validity is tested
using the "from date" on the claim. If the claim does not
contain at least one diagnosis code, this error is also generated.
EXAMPLES: 2785 is an invalid code; 2780 needs a fifthdigit.; and 5678
Peritonitis NEC is invalid for service dates on or after October 1,2005.
Return claim to provider (RTP).'
providerAction: 'The provider should resubmit the claim once the problem(s) is/are
corrected.'
- editNumber: '2'
editHospitalType: Both OPPS and non-OPPS edit
editDescription: Diagnosis and age conflict
editResults: 'This edit occurs when the diagnosis code includes an age range, and the
age reported is outside the range. It indicates that the diagnosis code is inconsistent
with the patient''s age. Age categories are as
follows:Newborn (age = 0) Pediatric (age = 0 to 17 years) Maternity (age
= 12 to 55 years) Adult (age=15 to 124) All ages (age 0 to 124 )
EXAMPLES: G0466 Abnormal Fetal Heart Rate Pre-Labor is appropriate only
for newborn patients. 33181 Reyes Syndrome is appropriate for pediatric
patients only. 63390 Ectopic Pregnancy without intrauterine pregnancy is
appropriate for maternity patients only. 501 Asbestosis is appropriate
only for adults.Return claim to provider (RTP).'
providerAction: The provider should resubmit the claim once the problem(s) is/are corrected.
editNumberLink:
value: '2'
href: /api/cms/facility/ioce-edits/codes-associated-with-edit/2
totalCount: 2
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/ioce-edits/99213
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/ioce-edits
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/ioce-edits/codes-associated-with-edit/{edit-number}:
get:
tags:
- I-OCE Edits APIs
summary: 'Facility - fetch codes associated with specified I-OCE edit number '
operationId: getCodesAssociatedForEdit
parameters:
- name: edit-number
in: path
required: true
schema:
type: integer
format: int32
example: 2
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is -code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - codes associated with specified fetch I-OCE edit number
content:
application/json:
example:
content:
- code: A18.14
codeDescription: Tuberculosis of prostate
- code: A18.15
codeDescription: Tuberculosis of other male genital organs
totalCount: 2
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/ioce-edits/codes-associated-with-edit/test
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/ioce-edits/codes-associated-with-edit/2
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/icd9/{code}/mce-edits:
get:
tags:
- MCE Edits ICD9 and ICD10 API
summary: Fetches MCE code edits for icd9 codes
operationId: getMCEEditsICD9
parameters:
- name: code
in: path
required: true
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MCE specific edit ICD9 codes
content:
application/json:
example:
- header: This edit detects an OR procedure code
description: Valid operating room procedure - A procedure that triggers a change in DRG
assignment.
- header: This is a postpayment edit that detects a bilateral procedure.
description: Bilateral Edit - Due to the lack of laterality in ICD-9-CM there are certain
lower extremity joint procedure codes that do not accurately reflect procedures that
are performed in one admission on two or more different bilateral joints. This edit
identifies procedure codes that when coded twice, represent the same procedure performed
on both of the same bilateral joints of the lower extremity. Otherwise, a code edit
will instruct the fiscal intermediary to verify that the two different procedures were
performed on two different bilateral joints. (MCE Edit 14).
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/icd91/81.51/mce-edits
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/icd9/81.51/mce-edits
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/icd10/{icd10Code}/mce-edits:
get:
tags:
- MCE Edits ICD9 and ICD10 API
summary: Fetches MCE Edits data based on icd10code
operationId: fetchMCEEditsICD10
parameters:
- name: icd10Code
in: path
required: true
schema:
type: string
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MCE Edits Data based on icd10code
content:
application/json:
example:
content:
- code: '3'
description: DUPLICATE OF PRINCIPAL DIAGNOSIS
definition: Any secondary diagnosis that is the same code as the principal diagnosis
is identified as a duplicate because the secondary code may cause an erroneous assignment
to an MS-DRG with complications. The contractor will delete the duplicate secondary
diagnosis and process the bill.
- code: '4'
description: AGE CONFLICT
definition: This edit identifies inconsistencies between a patient's age and any diagnosis
on the patient's record. The diagnosis is considered clinically impossible for a
patient in the stated age. Either the diagnosis or the age is considered inaccurate. The
contractor will return the claim for correction of this error.
associatedCodeLink:
value: '4'
href: /api/cms/facility/mce/associated-icd9/4
totalCount: 19
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-12T13:52:54.478+00:00'
status: 404
error: Not Found
path: /cmscommonms/api/cms/facility/icd1/02BK0ZZ/mce-edits
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-12T13:38:46.141+00:00'
status: 500
error: Internal Server Error
path: cmscommonms/api/cms/facility/icd10/02BK0ZZ/mce-edits?limit=0&page=1
message: 'java.lang.IllegalArgumentException: Page size must not be less than one'
security:
- bearerAuth: []
/api/cms/facility/health-care-reason-codes:
get:
tags:
- Health Care Decision Reason API
summary: Fetches the healthCare reason codes table data
operationId: getHealthCareReasonCodes
parameters:
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these values (code,-code) are allowed.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch Code and Description
content:
application/json:
example:
content:
- code: '01'
codeDescription: Price Authorization Expired
- code: '02'
codeDescription: Price authorization no longer required
- code: '03'
codeDescription: Product not on the price authorization
totalCount: 73
'400':
description: Bad request
content:
application/json:
example:
error:
- sort parameter value should be from list of [code, -code]
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/health-care-reason-codes
security:
- bearerAuth: []
/api/cms/facility/drg/{drg-code}/icd9/cross-codes:
get:
tags:
- DRG Information APIs
summary: Fetches the ICD9 specific codes for corresponding DRG cross code
operationId: getI9CodesForDrgCode
parameters:
- name: drg-code
in: path
description: Drg Cross Codes
required: true
schema:
type: string
example: '001'
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches the ICD9 specific codes for corresponding DRG cross code
content:
application/json:
example:
content:
- code: '174.0'
codeDescription: Malignant neoplasm of nipple and areola of female breast
- code: '175.0'
codeDescription: Malignant neoplasm of nipple and areola of male breast
totalCount: 2
'400':
description: Bad request
content:
application/json:
example:
error:
- 'filter : length must be between 2 and 180'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
path: /cmscommonms/api/cms/facility/drg/582/icd9/cross-codes
security:
- bearerAuth: []
/api/cms/facility/drg/{drg-code}/icd10/cross-codes:
get:
tags:
- DRG Information APIs
summary: Fetches the I10 specific codes for corresponding DRG cross code
operationId: getI10CodesForDrgCode
parameters:
- name: drg-code
in: path
description: Drg Cross Codes
required: true
schema:
type: string
example: '001'
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches the I10 specific codes for corresponding DRG cross code
content:
application/json:
example:
- sortOrder: '1'
term: Heart Transplant Operating Room Procedures
codes:
- code: 02YA0Z0
codeTypeId: '32768'
term: Transplantation of Heart, Allogeneic, Open Approach
exceptionFlag: N
- code: 02YA0Z1
codeTypeId: '32768'
term: Transplantation of Heart, Syngeneic, Open Approach
exceptionFlag: N
- code: 02YA0Z2
codeTypeId: '32768'
term: Transplantation of Heart, Zooplastic, Open Approach
exceptionFlag: N
- sortOrder: '2'
term: OR
indent: '2'
codes:
- code: 02RK0JZ
codeTypeId: '32768'
term: Replacement of Right Ventricle with Synthetic Substitute, Open Approach
exceptionFlag: N
'400':
description: Bad request
content:
application/json:
example:
error:
- 'drgCode : length must be between 3 and 3'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
path: /cmscommonms/api/cms/facility/drg/001/icd10/cross-codes
security:
- bearerAuth: []
/api/cms/facility/drg/{codetype}/all:
get:
tags:
- DRG Information APIs
summary: Fetches all DRG codes for given code group (icd9/icd10)
operationId: drgCodesAll
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- icd9
- icd10
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: sort
in: query
description: Any of these (drgCode,-drgCode) are allowed values.
required: false
schema:
type: array
items:
type: string
default:
- drgCode
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch MCE Edits Data
content:
application/json:
example:
content:
- drgCode: '010'
fullDescription: Pancreas Transplant
mdc: PRE
mdcDescription: Pre MDC
medSurg: S
gmLos: '7.8000'
amLos: '9.6000'
relativeWeight: '4.0849'
nationalPayment: '22055.4800'
- drgCode: '011'
fullDescription: Tracheostomy for Face, Mouth, and Neck Diagnoses with MCC
mdc: PRE
mdcDescription: Pre MDC
medSurg: S
gmLos: '11.3000'
amLos: '14.1000'
relativeWeight: '4.7380'
nationalPayment: '25581.7400'
- drgCode: '012'
fullDescription: Tracheostomy for Face, Mouth, and Neck Diagnoses with CC
mdc: PRE
mdcDescription: Pre MDC
medSurg: S
gmLos: '8.4000'
amLos: '10.0000'
relativeWeight: '3.3293'
nationalPayment: '17975.7900'
totalCount: 3
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'filter : length must be between 2 and 180'
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-12T13:52:54.478+00:00'
status: 404
error: Not Found
trace: 'org.springframework.web.servlet.resource.NoResourceFoundException: No static resource
api/cms/facility/drg/icd9/all.'
security:
- bearerAuth: []
/api/cms/facility/device-offset-code-pairs:
get:
tags:
- Device Offset Codes Pair APIs
summary: Fetches the device offset code pairs
operationId: getDeviceOffsetCodePairs
parameters:
- name: sort
in: query
description: Any of these (code1,-code1,code2,-code2) are allowed values, default is code1
required: false
schema:
type: array
items:
type: string
default:
- code1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - fetch the device offset code pairs
content:
application/json:
example:
content:
- code1: C1833
description1: Monitor, cardiac, including intracardiac lead and all system components
(implantable)
code2: 0525T
description2: Insertion or replacement of intracardiac ischemia monitoring system, including
testing of the lead and monitor, initial system programming, and imaging supervision
and interpretation; complete system (electrode and implantable monitor)
version: 95
offsetamount: '795.62'
- code1: C1833
description1: Monitor, cardiac, including intracardiac lead and all system components
(implantable)
code2: 0526T
description2: Insertion or replacement of intracardiac ischemia monitoring system, including
testing of the lead and monitor, initial system programming, and imaging supervision
and interpretation; electrode only
version: 95
offsetamount: '2509.33'
totalCount: 2
'400':
description: 'Bad Request: Filter parameter is invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'filter : length must be between 2 and 180'
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2024-04-24T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/device-offset-code-pairs
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/claim-status-codes:
get:
tags:
- Claim Status Code APIs
summary: Fetches the claim status codes
operationId: getClaimStatusCode
parameters:
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these values (code, -code)are allowed.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches the claim status codes
content:
application/json:
example:
content:
- code: '0'
description: 'Cannot provide further status electronically. Note: New as of: 01/01/1995'
- code: '1'
description: 'For more detailed information, see remittance advice. Note: New as of:
01/01/1995'
- code: '100'
description: 'Pre-certification penalty taken. Note: New as of: 01/01/1995'
totalCount: 3
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/claim-status-codes
security:
- bearerAuth: []
/api/cms/facility/claim-status-category-codes:
get:
tags:
- Claim Status Category Code APIs
summary: Fetches the claim status category codes
operationId: getClaimStatusCategoryCode
parameters:
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these values (code, -code) are allowed.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches the claim status category codes
content:
application/json:
example:
content:
- code: X0
description: 'Supplemental Messages Note: New as of: 01/01/1995 Deactivated: 10/16/2003'
- code: A0
description: 'Acknowledgement/Forwarded-The claim/encounter has been forwarded to another
entity. Note: New as of: 01/01/1995'
- code: A1
description: 'Acknowledgement/Receipt-The claim/encounter has been received. This does
not mean that the claim has been accepted for adjudication. Note: New as of: 01/01/1995'
totalCount: 3
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/claim-status-category-codes
security:
- bearerAuth: []
/api/cms/facility/cci/{code}/{column-type}:
get:
tags:
- CCI Edits APIs
summary: Facility - Fetch CCI Edits for single code
operationId: getSingleCodeView_1
parameters:
- name: code
in: path
required: true
schema:
type: string
example: 99213
- name: column-type
in: path
required: true
schema:
type: string
enum:
- primary
- secondary
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is -code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - Fetch CCI Edits for single code
content:
application/json:
example:
content:
- code: 0362T
description: Behavior identification supporting assessment, each 15 minutes of technicians'
time face-to-face with a patient
modifier: modifier allowed, codes may be used together if documentation supports their
use
- code: 0373T
description: Adaptive behavior treatment with protocol modification, each 15 minutes
of technicians' time face-to-face with a patient
modifier: modifier allowed, codes may be used together if documentation supports their
use
totalCount: 2
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/cci/invalid
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/cci
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/cci/print:
get:
tags:
- CCI Edits APIs
summary: Facility - Prints CCI Edits for multi code
operationId: printCCIResults_1
parameters:
- name: codes
in: query
description: Takes comma separated codes with minimum of 2 codes and maximum of 36 codes
required: true
schema:
type: string
example: 99213,99214
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
type: string
format: byte
security:
- bearerAuth: []
/api/cms/facility/cci/effective-date-version:
get:
tags:
- CCI Edits APIs
summary: Facility - Fetch CCI Edits Effective Date and Version Description
operationId: getCCIEffectiveDateAndVersionDesc
parameters:
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - Fetch CCI Edits Effective Date and Version Description
content:
application/json:
example:
versionDesc: 94
effDate: '2024-01-01 00:00:00'
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-03-06T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/cci/invalid
security:
- bearerAuth: []
/api/cms/facility/cci/conflict-view:
get:
tags:
- CCI Edits APIs
summary: Facility - fetch CCI edits for multi code conflict view
operationId: getMultiCodeCodeView_1
parameters:
- name: codes
in: query
description: Takes comma separated codes with minimum of 2 codes and maximum of 50 codes
required: true
schema:
type: string
example: 99213,99214
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - Fetch CCI Edits for CodeView or Conflict View
content:
application/json:
example:
- - code: '99214'
description: Office or other outpatient visit for the evaluation and management of an
established patient
modifier: modifier allowed, codes may be used together if documentation supports their
use
- code: '99213'
description: Office or other outpatient visit for the evaluation and management of an
established patient
modifier: modifier allowed, codes may be used together if documentation supports their
use
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/cci/invalid
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/cci
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/cci/cci-edits-list/{list-type}:
get:
tags:
- CCI Edits APIs
summary: Facility - fetch CCI edits list for all, addition and deleted codes
operationId: getCCIEditsList
parameters:
- name: list-type
in: path
required: true
schema:
type: string
enum:
- all
- addition
- deletion
- name: sort
in: query
description: Any of these (code1,-code1,code2,-code2,modifier,-modifier) are allowed values, default
is -code1
required: false
schema:
type: array
items:
type: string
default:
- code1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Facility - Fetch CCI Edits List for all, addition and deleted codes
content:
application/json:
example:
- - code1: 0001U
code2: 0029U
modifier: 1
versionDesc: 94
effDate: '2024-01-01 00:00:00'
- code1: 0001U
code2: 0030U
modifier: 1
versionDesc: 94
effDate: '2024-01-01 00:00:00'
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/cci/invalid
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/cci
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/facility/carc:
get:
tags:
- Claim Adjustment Reasons Codes APIs
summary: Facility - fetch claim adjustment reasons codes
operationId: fetchCARCList
parameters:
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is -code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch Claim Adjustment Reasons Codes
content:
application/json:
example:
content:
- code: '1'
description: 'Deductible Amount Note: New as of: 01/01/1995'
- code: '10'
description: 'The diagnosis is inconsistent with the patient''s gender. Usage: Refer
to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information
REF), if present. Note: New as of: 01/01/1995 Modified: 07/01/2017'
totalCount: 2
'400':
description: Bad Request - some parameters were invalid
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [adjustmentCode]
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-12-2T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than zero'
path: /cmscommonms/api/cms/facility/carc/?sort=adjustmentCode&limit=150&page=-1
security:
- bearerAuth: []
/api/cms/common/transmittal/{doc-id}/{doc-source-id}/transmittal-download:
get:
tags:
- CMS Transmittal APIs
summary: Fetches the file content for CMS Transmittal
operationId: getCMSTransmittalDocument
parameters:
- name: doc-id
in: path
description: Transmittal Document ID
required: true
schema:
type: integer
format: int32
example: 619114
- name: doc-source-id
in: path
description: 'Transmittal Document Source Id '
required: true
schema:
type: integer
format: int32
example: 4
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches The file content in the form of byte array, response headers and media
type as FileType
content:
application/pdf:
schema:
$ref: '#/components/schemas/Notification'
example: " access-control-expose-headers: Content-Disposition \n cache-control: no-cache,no-store,max-age=0,must-revalidate\
\ \n connection: keep-alive \n content-disposition: attachment; filename=R12138OTN.pdf\
\ \n content-length: 178521 \n content-type: application/pdf \n date: Fri,28 Jul 2023\
\ 12:03:02 GMT \n expires: 0 \n pragma: no-cache \n vary: Origin,Access-Control-Request-Method,Access-Control-Request-Headers\
\ \n x-content-type-options: nosniff \n x-frame-options: DENY \n x-xss-protection: 0 \n"
'404':
description: 'Not found: Sub terms not found'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-28T06:19:48.666+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/transmittal/{docId}/{docSourceId}transmittal-download
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:19:48.666+00:00'
path: /cmscommonms/api/cms/common/transmittal/{docId}/{docSourceId}transmittal-download
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/cms/common/transmittal/{code}:
get:
tags:
- CMS Transmittal APIs
summary: Fetches the data for the CMS Transmittal for given CPT ,HCPCS code
operationId: getCodeDetailCMSTransmittals
parameters:
- name: code
in: path
required: true
schema:
type: string
example: 13152
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches transmittals for the given CPT or HCPCS code
content:
application/json:
example:
- docId: 615607
documentSourceId: 4
transmittalNumber: R12052CP
postDate: '2023-05-18 00:00:00'
effectiveDate: '2023-07-01 00:00:00'
rescinded: Y
replacedBy: R12062CP
fileName: R12052CP
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-10-18T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/transmittal/{code}/
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-10-18T07:22:01.017+00:00'
path: /cmscommonms/api/cms/common/transmittal/{code}/
status: 500
error: Internal Server Error
requestId: a4796cc7-1
security:
- bearerAuth: []
/api/cms/common/release-date/{id}:
get:
tags:
- Release Dates API
summary: Fetches release date for particular Id
operationId: getReleaseDate
parameters:
- name: id
in: path
required: true
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch Release Date for particular Id
content:
application/json:
example:
releaseDate: '2023-01-01 00:00:00'
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
status: 400
error: Bad Request
message: Bad Request
path: /cmscommonms/api/cms/common/release-date/AMB1
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/release-date/AMB
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/policy-lookup/{policy-type}/{policy-number}:
get:
tags:
- Policy Lookup APIs
summary: Fetches all the policies of a given policy type and policy id
operationId: fetchPolicyByIdValue
parameters:
- name: sort
in: query
description: Any of these (contractorType,-contractorType,serviceAreas,-serviceAreas) are allowed
values, default is -contractorType
required: false
schema:
type: array
items:
type: string
default:
- contractorType
- name: policy-type
in: path
description: Policy Number
required: true
schema:
type: string
enum:
- NCD_PART_A
- NCD_PART_B
- LCD_DME
- NCD_DME
- LCD_PART_A
- LCD_PART_B
- NCD_LAB
example: LCD
- name: policy-number
in: path
description: Policy Number
required: true
schema:
type: string
example: L39314
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Search Policies by policy Id
content:
application/json:
example:
content:
- icpContractorId: 222
icpPolicyId: 532655
determinationNum: L39314
contractorType: MB
contractorName: National Government Services, Inc.
policyType: LCD
cms: L39314
policyTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
effectiveDate: '2022-11-01'
url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39314&ver=7&bc=0
serviceAreas: IL
contractorNum: '06102'
hasArticles: '2'
displayName: Off-Label Use of Intravenous Immune Globulin (IVIG)
scrubbedTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
contractorServiceAreas: 06102 - National Government Services, Inc. (IL)
contractorTypeDisplayName: Part B
- icpContractorId: 223
icpPolicyId: 532656
determinationNum: L39314
contractorType: MB
contractorName: National Government Services, Inc.
policyType: LCD
cms: L39314
policyTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
effectiveDate: '2022-11-01'
url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39314&ver=7&bc=0
serviceAreas: MN
contractorNum: '06202'
hasArticles: '2'
displayName: Off-Label Use of Intravenous Immune Globulin (IVIG)
scrubbedTitle: Off-Label Use of Intravenous Immune Globulin (IVIG)
contractorServiceAreas: 06202 - National Government Services, Inc. (MN)
contractorTypeDisplayName: Part B
totalCount: 22
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/policy-lookupp/L39313
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/policy-lookup
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/policy-list/ncd/{contractorPart}:
get:
tags:
- Medicare Coverage Policy for part A and Part B APIs
summary: Fetches NCD Policies for particular Contractor part
operationId: getMedicareNCDPolicyList
parameters:
- name: contractorPart
in: path
required: true
schema:
type: string
enum:
- DME
- B
- A
- LAB
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches NCD policies for particular contractor part
content:
application/json:
example:
content:
- icpContractorId: 0
icpPolicyId: 274765
determinationNum: 240.2.1
policyType: NCD
cms: 240.2.1
policyTitle: NCD for Home Use of Oxygen in Approved Clinical Trials (240.2.1)
effectiveDate: '2006-03-20'
url: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=312&ncdver=1&DocID=240.2.1&bc=gAAAAAgAAAAAAA%3d%3d&
hasArticles: '0'
displayName: 'Home Use of Oxygen in Approved Clinical Trials '
totalCount: 1
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '992133' in this web service request is not a valid 'cpt' code.
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/physician/policy-list/NCD/C/A4575
security:
- bearerAuth: []
/api/cms/common/policy-list/lcd/{contractorPart}:
get:
tags:
- Medicare Coverage Policy for part A and Part B APIs
summary: Fetches LCD policies for particular contractor id , contractor part
operationId: getMedicareLCDPolicyList
parameters:
- name: contractorPart
in: path
required: true
schema:
type: string
enum:
- A
- B
- DME
- name: sort
in: query
description: Any of these (serviceAreas,-serviceAreas) are allowed values, default is serviceAreas
required: false
schema:
type: array
items:
type: string
default:
- serviceAreas
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: contractor-id
in: query
required: false
schema:
type: integer
format: int32
example: 128
- name: is-retired-policies
in: query
required: false
schema:
type: boolean
default: true
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches LCD policies for particular contractor id , contractor part
content:
application/json:
example:
content:
- icpContractorId: 128
icpPolicyId: 528715
determinationNum: L37873
contractorType: MA
contractorName: Palmetto GBA
policyType: LCD
cms: L37873
policyTitle: Topical Oxygen Therapy
effectiveDate: '2019-05-06'
url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37873&ver=14&bc=0
serviceAreas: SC
contractorNum: '11201'
hasArticles: '2'
totalCount: 1
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/policy-list/LCD/C?contractor_id=128
security:
- bearerAuth: []
/api/cms/common/noc/pricing-list:
get:
tags:
- Not Otherwise Classified (NOC) Drug Pricing APIs
summary: Fetches NOC pricing list
operationId: getNocDrugPriceList
parameters:
- name: sort
in: query
description: Any of these (code,-code,ndc,-ndc,genericName,-genericName,dosage,-dosage,pay,-pay,notes,-notes)
are allowed values, default is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch NOC pricing list
content:
application/json:
example:
content:
- code: J3410
ndc: '00641602110'
genericName: Famotidine
dosage: 10 MG
pay: '.417'
notes: null
- code: J3490
ndc: '00003256016'
genericName: Aztreonam
dosage: 500 MG
pay: '14.775'
notes: null
totalCount: 145
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/noc/pricing-list1
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/noc/pricing-list
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/medicare-contractors:
get:
tags:
- Policy Lookup APIs
summary: Fetches medicare contractors list for a given contractor part.
operationId: fetchMedicareContractors
parameters:
- name: contractor-part
in: query
description: Any of these contractor parts (A or B or DME) are allowed, default is A.
required: false
schema:
type: string
enum:
- A
- B
- DME
example: A
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: OK
content:
'*/*':
schema:
type: array
items:
$ref: '#/components/schemas/ContractorValue'
security:
- bearerAuth: []
/api/cms/common/hcc/{hccType}/{hccCode}/diagnosis-codes:
get:
tags:
- CMS HCC APIs
summary: Fetches diagnosis codes on selected hcc type and hcc code
operationId: getDiagnosisCodes
parameters:
- name: hccType
in: path
required: true
schema:
type: string
enum:
- CMS_HCC
- CMS_HCC_ESRD
- RX_HCC_V04
- HHS_HCC
- name: hccCode
in: path
description: HCC Types
required: true
schema:
type: string
example: HCC1
- name: sort
in: query
description: Any of these (diagnosisCode,-diagnosisCode) are allowed values, default is diagnosisCode
required: false
schema:
type: array
items:
type: string
default:
- diagnosisCode
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: 'Fetches diagnosis codes for the given hcc code '
content:
application/json:
example:
- diagnosisCode: B20
diagnosisCodeDesc: Human immunodeficiency virus [HIV] disease
- diagnosisCode: B97.35
diagnosisCodeDesc: Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases
classified elsewhere
- diagnosisCode: Z21
diagnosisCodeDesc: Asymptomatic human immunodeficiency virus [HIV] infection status
'400':
description: Bad Request - some parameters were invalid
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [diagnosisCode]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/hcc/{hccType}/{hccCode}/hcc-diagnosis-
security:
- bearerAuth: []
/api/cms/common/hcc/{hccType}/codes:
get:
tags:
- CMS HCC APIs
summary: 'Fetches hcc type specific codes '
operationId: getHCCCodes
parameters:
- name: hccType
in: path
description: Fetches HCC codes on selected hcc type
required: true
schema:
type: string
enum:
- CMS_HCC
- CMS_HCC_ESRD
- RX_HCC_V04
- HHS_HCC
- name: sort
in: query
description: Any of these (hccCode,-hccCode) are allowed values, default is hccCode
required: false
schema:
type: array
items:
type: string
default:
- hccCode
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches hcc codes from the selected hcc type
content:
application/json:
example: "[{\n \"hccCode\": \"HCC1\",\n \"hccCodeDesc\": \"HIV/AIDS\"\n \
\ },\n {\n \"hccCode\": \"HCC2\",\n \"hccCodeDesc\": \"Septicemia,\
\ Sepsis, Systemic Inflammatory Response Syndrome/Shock\"\n },\n {\n \
\ \"hccCode\": \"HCC6\",\n \"hccCodeDesc\": \"Opportunistic Infections\"\n \
\ },]\n"
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [hccCode]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-08-04T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/hcc/{hccType}/cod
security:
- bearerAuth: []
/api/cms/common/hcc/{codetype}/{code}/code:
get:
tags:
- CMS HCC APIs
summary: Fetches hcc codes for the given diagnosis code
operationId: getHCCDiagnosisCodes
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- i10_cm
- i9v1
- name: code
in: path
required: true
schema:
type: string
example: B20
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches hcc codes for the given diagnosis code
content:
application/json:
example:
cmsHCC:
- hccCode: HCC1
hccCodeDesc: HIV/AIDS
cmsHCCESRD:
- hccCode: HCC1
hccCodeDesc: HIV/AIDS
rxHCC:
- hccCode: RXHCC1
hccCodeDesc: HIV/AIDS
hhsHCC:
- hccCode: HCC1
hccCodeDesc: HIV/AIDS
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- The code provided '992133' in this web service request is not a valid 'I10_CM' code.
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/hcc/I10_CM/{code}/codes
security:
- bearerAuth: []
/api/cms/common/fee-schedule/{fee-schedule-type}:
get:
tags:
- DME and PEN Fee Schedule APIs
summary: Fetches DME or PEN fee schedule for all states
operationId: getOutpatientFees
parameters:
- name: fee-schedule-type
in: path
required: true
schema:
type: string
enum:
- DME
- PEN
- name: sort
in: query
description: Any of these (code,-code,modifier,-modifier,modifier2,-modifier2,category,-category,state,-state,nonRuralFee,-nonRuralFee,ruralFee,-ruralFee)
are allowed values.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch DME/PEN fees for all states
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
content:
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: AZ
nonRuralFee: '0.58'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: CA
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: CO
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: CT
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: DC
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: DE
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: FL
nonRuralFee: '0.55'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: GA
nonRuralFee: '0.59'
ruralFee: '0.00'
totalCount: 2
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-08-14T16:46:24.623+00:00'
status: 400
error: Bad Request
path: /cmscommonms/api/cms/common/fee-schedule/test
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/DME
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/fee-schedule/{fee-schedule-type}/{state}:
get:
tags:
- DME and PEN Fee Schedule APIs
summary: Fetches DME OR PEN fee schedule for specific state
operationId: getOutpatientFees_1
parameters:
- name: fee-schedule-type
in: path
required: true
schema:
type: string
enum:
- DME
- PEN
- name: state
in: path
description: State
required: true
schema:
type: string
example: AL
- name: sort
in: query
description: Any of these (code,-code,modifier,-modifier,modifier2,-modifier2,category,-category,state,-state,nonRuralFee,-nonRuralFee,ruralFee,-ruralFee)
are allowed values.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch DME/PEN Fees for specific state
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
content:
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: AL
nonRuralFee: '0.55'
ruralFee: '0.00'
- code: A4217
codeDescription: Sterile water/saline, 500 ml
modifier: AU
category: OS
state: AL
nonRuralFee: '3.54'
ruralFee: '0.00'
- code: A4217
codeDescription: Sterile water/saline, 500 ml
category: SU
state: AL
nonRuralFee: '3.54'
ruralFee: '0.00'
- code: A4221
codeDescription: Supplies for maintenance of noninsulin drug infusion catheter, per
week (list drugs separately)
category: SU
state: AL
nonRuralFee: '25.41'
ruralFee: '26.97'
- code: A4222
codeDescription: Infusion supplies for external drug infusion pump, per cassette or
bag (list drugs separately)
category: SU
state: AL
nonRuralFee: '49.45'
ruralFee: '53.68'
- code: A4224
codeDescription: Supplies for maintenance of insulin infusion catheter, per week
category: SU
state: AL
nonRuralFee: '25.41'
ruralFee: '26.97'
- code: A4225
codeDescription: Supplies for external insulin infusion pump, syringe type cartridge,
sterile, each
category: SU
state: AL
nonRuralFee: '3.28'
ruralFee: '3.36'
- code: A4233
codeDescription: Replacement battery, alkaline (other than J cell), for use with medically
necessary home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '0.51'
ruralFee: '0.00'
- code: A4234
codeDescription: Replacement battery, alkaline, J cell, for use with medically necessary
home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '2.36'
ruralFee: '0.00'
- code: A4235
codeDescription: Replacement battery, lithium, for use with medically necessary home
blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '1.00'
ruralFee: '0.00'
- code: A4236
codeDescription: Replacement battery, silver oxide, for use with medically necessary
home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '1.16'
ruralFee: '0.00'
- code: A4238
codeDescription: Supply allowance for adjunctive, nonimplanted continuous glucose monitor
(CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
modifier: KF
category: SU
state: AL
nonRuralFee: '261.95'
ruralFee: '0.00'
- code: A4239
codeDescription: Supply allowance for nonadjunctive, nonimplanted continuous glucose
monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
modifier: KF
category: SU
state: AL
nonRuralFee: '296.72'
ruralFee: '0.00'
- code: A4239
codeDescription: Supply allowance for nonadjunctive, nonimplanted continuous glucose
monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
category: SU
state: AL
nonRuralFee: '255.01'
ruralFee: '0.00'
- code: A4253
codeDescription: Blood glucose test or reagent strips for home blood glucose monitor,
per 50 strips
modifier: NU
category: IN
state: AL
nonRuralFee: '8.32'
ruralFee: '0.00'
- code: A4255
codeDescription: Platforms for home blood glucose monitor, 50 per box
category: SU
state: AL
nonRuralFee: '5.47'
ruralFee: '0.00'
- code: A4256
codeDescription: Normal, low, and high calibrator solution/chips
category: SU
state: AL
nonRuralFee: '3.38'
ruralFee: '0.00'
- code: A4257
codeDescription: Replacement lens shield cartridge for use with laser skin piercing
device, each
category: SU
state: AL
nonRuralFee: '16.97'
ruralFee: '0.00'
totalCount: 3367
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- Invalid state value. Length should be 2
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/DME/AL
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/fee-schedule/zip-code/{state}:
get:
tags:
- DME and PEN Fee Schedule APIs
summary: Fetches rural ZIP codes available for given state
operationId: getZipCodes
parameters:
- name: state
in: path
description: State
required: true
schema:
type: string
example: AL
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch DME fees for all states
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
content:
- zipCode: '35010'
- zipCode: '35011'
- zipCode: '35014'
- zipCode: '35016'
- zipCode: '35019'
totalCount: 5
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'getZipCodes.filter: length must be between 2 and 30'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/zip-codes/AL
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/fee-schedule/states/state-list:
get:
tags:
- State List Fee Schedule APIs
summary: Fetches state list for fee schedule
operationId: getStateList
parameters:
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetches state list for fee schedule
content:
application/json:
example:
- AK
- AL
- AR
- AZ
- CA
- CO
- CT
- DC
- DE
- FL
- GA
- HI
- IA
- ID
- IL
- IN
- KS
- KY
- LA
- MA
- MD
- ME
- MI
- MN
- MO
- MS
- MT
- NC
- ND
- NE
- NH
- NJ
- NM
- NV
- NY
- OH
- OK
- OR
- PA
- PR
- RI
- SC
- SD
- TN
- TX
- UT
- VA
- VI
- VT
- WA
- WI
- WV
- WY
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/states/state-list
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/clinical-diagnostic:
get:
tags:
- Clinical Diagnostic Laboratory APIs
summary: Fetches the clinical diagnostic laboratory table data
operationId: getClinicalDiagnostic
parameters:
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: sort
in: query
description: Any of these values (code, -code, payment, -payment,modifier,-modifier)are allowed.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch average sales price
content:
application/json:
example:
content:
- code: 0021U
codeDescription: Oncology (prostate), detection of 8 autoantibodies (ARF 6, NKX3-1,
5'-UTR-BMI1, CEP 164, 3'-UTR-Ropporin, Desmocollin, AURKAIP-1, CSNK2A2), multiplexed
immunoassay and flow cytometry serum, algorithm reported as risk score
payment: '760.00'
- code: 0022U
codeDescription: Targeted genomic sequence analysis panel, non-small cell lung neoplasia,
DNA and RNA analysis, 23 genes, interrogation for sequence variants and rearrangements,
reported as presence or absence of variants and associated therapy(ies) to consider
payment: '0.00'
- code: 0023U
codeDescription: Oncology (acute myelogenous leukemia), DNA, genotyping of internal
tandem duplication, p.D835, p.I836, using mononuclear cells, reported as detection
or non-detection of FLT3 mutation and indication for or against the use of midostaurin
payment: '248.51'
- code: 0024U
codeDescription: Glycosylated acute phase proteins (GlycA), nuclear magnetic resonance
spectroscopy, quantitative
payment: '34.19'
- code: 0025U
codeDescription: Tenofovir, by liquid chromatography with tandem mass spectrometry (LC-MS/MS),
urine, quantitative
payment: '85.77'
- code: 0026U
codeDescription: Oncology (thyroid), DNA and mRNA of 112 genes, next-generation sequencing,
fine needle aspirate of thyroid nodule, algorithmic analysis reported as a categorical
result ("Positive, high probability of malignancy" or "Negative, low probability of
malignancy")
payment: '3600.00'
- code: 0027U
codeDescription: JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis,
targeted sequence analysis exons 12-15
payment: '121.91'
- code: 0029U
codeDescription: Drug metabolism (adverse drug reactions and drug response), targeted
sequence analysis (ie, CYP1A2, CYP2C19, CYP2C9, CYP2D6, CYP3A4, CYP3A5, CYP4F2, SLCO1B1,
VKORC1 and rs12777823)
payment: '742.27'
- code: '80418'
codeDescription: 'Combined rapid anterior pituitary evaluation panel This panel must
include the following: Adrenocorticotropic hormone (ACTH) (82024 x 4) Luteinizing
hormone (LH) (83002 x 4) Follicle stimulating hormone (FSH) (83001 x 4) Prolactin
(84146 x 4) Human growth hormone (HGH) (83003 x 4) Cortisol (82533 x 4) Thyroid stimulating
hormone (TSH) (84443 x 4)'
payment: '579.48'
- code: '80426'
codeDescription: 'Gonadotropin releasing hormone stimulation panel This panel must include
the following: Follicle stimulating hormone (FSH) (83001 x 4) Luteinizing hormone
(LH) (83002 x 4)'
payment: '148.41'
totalCount: 10
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code, modifier, payment]
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/common/clinical-diagnostic
security:
- bearerAuth: []
/api/cms/common/average-sales/sales-price:
get:
tags:
- Average Sales Price APIs
summary: Fetches the Average Sales Price Drug table data
operationId: getAverageSales
parameters:
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: sort
in: query
description: Any of these (code,-code,dosage,-dosage,paymentLimit,-paymentLimit,vaccineAWP,-vaccineAWP,vaccineLimit,-vaccineLimit,bloodAWP,-bloodAWP,bloodLimit,-bloodLimit,notes,-notes)
are allowed values.
required: false
schema:
type: array
items:
type: string
default:
- code
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch average sales price
content:
application/json:
example:
content:
- code: '90714'
codeDescription: Td vacc no presv 7 yrs+ im
dosage: 0.5 ML
paymentLimit: '31.045'
- code: J0134
codeDescription: Inj acetaminophen -fresenius
dosage: 10 MG
paymentLimit: '0.069'
- code: J0612
codeDescription: Calcium glucon (fresenius)
dosage: 10 MG
paymentLimit: '0.055'
- code: J1611
codeDescription: Inj glucagon hcl, fresenius
dosage: 1 MG
paymentLimit: '101.412'
notes: AMP-based payment limit
- code: J2272
codeDescription: Inj, morphine (fresenius)
dosage: 10 MG
paymentLimit: '6.929'
- code: J2281
codeDescription: Inj moxifloxacin (fres kabi)
dosage: 100 MG
paymentLimit: '4.495'
notes: AMP-based payment limit
- code: J2597
codeDescription: Inj desmopressin acetate
dosage: 1 MCG
paymentLimit: '7.271'
- code: J2598
codeDescription: Inj, vasopressin, 1 unit
dosage: 1 UNIT
paymentLimit: '2.919'
notes: Added July 2023
- code: J2599
codeDescription: Inj vasopressin (am reg) 1 u
dosage: 1 UNIT
paymentLimit: '2.098'
notes: Added July 2023
- code: J2786
codeDescription: Injection, reslizumab, 1mg
dosage: 1 MG
paymentLimit: '10.198'
- code: J9394
codeDescription: Inj, fulvestrant (fresenius)
dosage: 25 MG
paymentLimit: '1.653'
totalCount: 11
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code, dosage, paymentLimit, vaccineAWP,
vaccineLimit, bloodAWP, bloodLimit, notes]
warning: null
info: null
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-27T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/common/average-sales/sales-price
security:
- bearerAuth: []
/api/cms/common/ambulance/medicare-localities:
get:
tags:
- Ambulance Fee Schedule APIs
summary: Fetches medicare localities
operationId: getMedicareCarrierLocalities
parameters:
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch medicare localities
content:
application/json:
example:
- carrier: '10112'
locality: '00'
state: Alabama
- carrier: '02102'
locality: '01'
state: Alaska
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-14T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/common/ambulance/medicare-localities1
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/ambulance/medicare-localities
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/ambulance/ambulance-fee-schedule/{carrier}/{locality}:
get:
tags:
- Ambulance Fee Schedule APIs
summary: Fetches Ambulance Fees
operationId: getAmbulanceFees
parameters:
- name: carrier
in: path
description: Carrier value
required: true
schema:
type: string
example: 10112
- name: locality
in: path
description: Locality value
required: true
schema:
type: string
example: '00'
- name: sort
in: query
description: Any of these (code,-code) are allowed values, default is +code
required: false
schema:
type: array
items:
type: string
default:
- code
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 150
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: filter
in: query
required: false
schema:
type: string
- name: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
responses:
'200':
description: Fetch ambulance fees
content:
application/json:
example:
content:
- code: A0425
codeDescription: Ground mileage, per statute mile
baseRateUrbanMiles: '8.71'
ruralBaseRateMileage: '8.80'
ruralBaseRateLowestQ: null
ruralBaseMiles117: '13.20'
- code: A0426
codeDescription: Ambulance service, advanced life support, nonemergency transport, level
1 (ALS 1)
baseRateUrbanMiles: '297.26'
ruralBaseRateMileage: '300.18'
ruralBaseRateLowestQ: '368.02'
ruralBaseMiles117: null
totalCount: 2
'400':
description: 'Bad request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- Not a valid medicareLocality
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/ambulance/ambulance-fee-schedule/10112/00
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
components:
schemas:
QPPMipsValue:
type: object
properties:
measureId:
type: string
docId:
type: string
description:
type: string
collectionType:
type: string
specialtyMeasure:
type: string
measureType:
type: string
highPriority:
type: string
message:
type: string
Notification:
type: object
properties:
error:
type: array
items:
type: string
warning:
type: array
items:
type: string
info:
type: array
items:
type: string
SupportingDocument:
type: object
properties:
docId:
type: integer
format: int32
publicationType:
type: string
fileName:
type: string
publicationSubject:
type: string
postDate:
type: string
effectiveDate:
type: string
CMSTransmittal:
type: object
properties:
docId:
type: integer
format: int32
documentSourceId:
type: integer
format: int32
publicationType:
type: string
publicationSubject:
type: string
transmittalNumber:
type: string
changeRequest:
type: string
postDate:
type: string
effectiveDate:
type: string
docImpDate:
type: string
rescinded:
type: string
replacedBy:
type: string
relatedDocName:
type: string
retroactiveFlag:
type: string
healthCareTypes:
type: string
specialities:
type: string
ascFlag:
type: string
fileName:
type: string
code:
type: string
DiagnosisCode:
type: object
properties:
code:
type: string
codeType:
type: string
Lcd:
type: object
properties:
carrierId:
type: integer
format: int32
fiId:
type: integer
format: int32
dmeId:
type: integer
format: int32
retiredPolicies:
type: boolean
PolicySearchRequest:
type: object
properties:
policyType:
type: string
enum:
- NCD_PART_A
- NCD_PART_B
- LCD_DME
- NCD_DME
- LCD_PART_A
- LCD_PART_B
- NCD_LAB
searchType:
type: string
procedureCode:
type: string
termSearch:
$ref: '#/components/schemas/TermSearch'
diagnosisCode:
$ref: '#/components/schemas/DiagnosisCode'
effectiveDate:
type: string
format: date-time
lcd:
$ref: '#/components/schemas/Lcd'
TermSearch:
type: object
properties:
keyword:
type: string
searchBy:
type: string
searchLogic:
type: string
PolicyValue:
type: object
properties:
icpContractorId:
type: integer
format: int64
icpPolicyId:
type: integer
format: int64
determinationNum:
type: string
contractorType:
type: string
contractorName:
type: string
policyType:
type: string
cms:
type: string
policyTitle:
type: string
effectiveDate:
type: string
format: date-time
expirationDate:
type: string
format: date-time
url:
type: string
contractorURL:
type: string
activeRetiredStatus:
type: string
serviceAreas:
type: string
contractorNum:
type: string
hasArticles:
type: string
titleShort:
type: string
userDefinedEffectiveDate:
type: string
scrubbedTitle:
type: string
displayName:
type: string
contractorServiceAreas:
type: string
contractorTypeDisplayName:
type: string
ModifiersPopUpValue:
type: object
properties:
modifier:
type: string
description:
type: string
OptumPageImplModifiersPopUpValue:
type: object
properties:
content:
type: array
items:
$ref: '#/components/schemas/ModifiersPopUpValue'
totalCount:
type: integer
format: int64
ContractorValue:
type: object
properties:
contractorNum:
type: string
stateAbbr:
type: string
contractorName:
type: string
regionCode:
type: string
contractorType:
type: string
url:
type: string
contractorEid:
type: string
icpContractorId:
type: string
securitySchemes:
bearerAuth:
type: http
scheme: bearer
bearerFormat: JWT
x-readme:
explorer-enabled: true
proxy-enabled: true