openapi: 3.0.1 info: title: CMS Common Physician 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/physician/qpp/: post: tags: - QPP MIPS APIs summary: Fetches the data for the quality performance category measures look-up operationId: getTableData parameters: - name: sort in: query description: Any of these values (measureId,-measureId,collectionType,-collectionType,specialtyMeasure,-specialtyMeasure,measureType,-measureType,highPriority,-highPriority) are allowed.The default is code required: false schema: type: array items: type: string default: - measureId - 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: QPP MIPS Search Request content: application/json: schema: $ref: '#/components/schemas/QPPMipsValue' examples: QPP MIPS Search Request: description: QPP MIPS Search Request value: code: '' measureId: '' collectionType: '' specialtyMeasure: '' measureType: '' highPriority: '' required: true responses: '200': description: 'POST-for-GET: Fetch QPP data ' content: application/json: example: content: - measureId: '1' docId: '599161' description: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period. collectionType: Claims specialtyMeasure: General Practice/Family Medicine measureType: Intermediate Outcome highPriority: 'Yes' 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/physician/qpp/1 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/qpp/ 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/physician/{code}/physician-time: get: tags: - Medicare Fee Schedule APIs summary: Fetches Physician time for particular CPT or HCPCS code operationId: getPhysicianTime parameters: - name: code in: path description: CPT or HCPCS code required: true schema: type: string example: 14000 - 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 Physician Time content: application/json: example: physicianTime: 348 unit: minutes '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/14000/physician-time1 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/14000/physician-time status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/qpp/{doc-id}/mips-download: get: tags: - QPP MIPS APIs summary: 'Generates the data for the quality performance category ' operationId: qppMipsDocument parameters: - name: doc-id in: path description: MIPS Measure ID required: true schema: type: integer format: int32 example: 599161 - 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/physician/qpp/{doc-id}mips-download '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:19:48.666+00:00' path: /cmscommonms/api/cms/physician/qpp/{doc-id}mips-download status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/cms/physician/qpp/specialty-measures: get: tags: - QPP MIPS APIs summary: Generates the data for the quality performance category speciality-measures operationId: getSpecialtyMeasures 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 specialty measures content: application/json: example: - Allergy/Immunology - Anesthesiology - Cardiology - Dentistry - Dermatology - Diagnostic Radiology '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/qpp/specialty-measures1 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/qpp/specialty-measures status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/qpp/measure-types: get: tags: - QPP MIPS APIs summary: Generates the data for the quality performance category for measure types operationId: getMeasureTypes 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 Specialty Measures content: application/json: example: - Efficiency - Intermediate Outcome - Outcome - Patient Engagement/Experience - Patient-Reported Outcome-Based Performance Measure - Process - Structure '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/qpp/measure-types1 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/qpp/measure-types status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/status-codes: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS Status codes operationId: getStatusCodes 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 MPFS status codes content: application/json: example: content: - code: A description: Active Code definition: These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. totalCount: 17 '404': description: Not found content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2023-12-06T06:37:03.741+00:00' status: 404 error: Not Found message: Not Found path: /cmscommonms/api/cms/physician/mpfs/status-codes1 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/status-codes status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/payment-indicators/{ruletype}: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS payment indicators and its definitions for particular medicare rule type operationId: getPaymentIndicatorList parameters: - name: ruletype in: path required: true schema: type: string enum: - PCTC - MULT_PROC - ASST_SURG - BILAT_SURG - CO_SURG - PHYS_SUP - TEAM_SURG - 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: MPFS payment indicators and its definitions for particular medicare rule type content: application/json: example: content: - paymentIndicator: '0' definition: Team surgeons are not permitted for this procedure. - paymentIndicator: '1' definition: Team surgeons may be allowed with supporting documentation to establish medical necessity. - paymentIndicator: '2' definition: 'Team surgeons permitted, pay by report. ' - paymentIndicator: '9' definition: Team surgery concept does not apply totalCount: 4 '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/mpfs/payment-indicators/AAA '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/payment-indicators/TEAM_SURG status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/payment-indicator-status/{code}: get: tags: - Medicare Fee Schedule APIs summary: Fetches payment indicator and status information for CPT or HCPCS codes operationId: fetchPaymentIndicatorAndStatusFees parameters: - name: code in: path required: true schema: type: string example: 99213 - 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 payment indicator and status information for CPT or HCPCS codes content: application/json: example: " {{\n \"Global\": {\n \"pctc\": 0,\n \"multProc\": 0,\n\ \ \"bilatSurg\": 0,\n \"asstSurg\": 0,\n \"coSurg\": 0,\n \ \ \"teamSurg\": 0,\n \"status\": \"A\",\n \"physSup\": \"09\",\n \ \ \"modifier\": \" \",\n \"statusDesc\": \"Active Code. These codes are\ \ paid separately under the physician fee schedule, if covered. There will be RVUs for\ \ codes with this status. The presence of an \\\"A\\\" indicator does not mean that Medicare\ \ has made a national coverage determination regarding the service; carriers remain responsible\ \ for coverage decisions in the absence of a national Medicare policy.\",\n \"\ pctcDesc\": \"PC/TC Indicator|Physician service codes: This indicator identifies codes\ \ that describe physician services\",\n \"multProcDesc\": \"Multiple Procedures|No\ \ payment adjustment rules apply. If the procedure is reported on the same day as another\ \ procedure, the procedure is paid at the lower of the actual charge or the fee schedule\ \ amount for the procedure\",\n \"bilatSurgDesc\": null,\n \"asstSurgDesc\"\ : \"Surgical Assistant|Payment restriction for assistants at surgery applies to this procedure\ \ unless supporting documentation is submitted to establish medical necessity.\",\n \ \ \"teamSurgDesc\": \"Team Surgery|Team surgeons are not permitted for this procedure.\"\ ,\n \"physSurgDesc\": \"Physician Supervision of Diagnostic Procedures|Concept\ \ does not apply\",\n \"coSurgDesc\": \"Co-surgeons|Co-surgeons are not permitted\ \ for this procedure.\"\n }\n }\n }\n" '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/mpfs/payment-indicator-status1/99213 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/payment-indicator-status/99213 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/national-physician-relative-file: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS file content particular medicare rule type operationId: getRelativeFile 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 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=RVU3C.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/mpfs/national-physician-relative-file '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:19:48.666+00:00' path: /cmscommonms/api/cms/mpfs/national-physician-relative-file status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/cms/physician/mpfs/global-days/{code}: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS global days for CPT and HCPCS code operationId: getGlobalDays parameters: - name: code in: path required: true schema: type: string example: 99213 - 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 MPFS global days for CPT and HCPCS code content: application/json: example: preop: 0 intraop: 0 postop: 0 globalDays: '000' '400': description: Bad request content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - 'code : Invalid CPT or HCPCS value. Length should be 5' 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/mpfs/global-day/99213 '500': description: Internal server error content: application/json: example: timestamp: '2024-01-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/global-days/99213 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/fee-schedule/{codetype}/{code}/{carrier}/{locality}: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS fee schedule operationId: fetchMedicareFees parameters: - name: codetype in: path required: true schema: type: string enum: - hcpcs - cpt - name: code in: path required: true schema: type: string example: 99213 - name: carrier in: path description: Carrier value required: true schema: type: string example: '00000' - name: locality in: path description: Locality value required: true schema: type: string example: '00' - name: cf in: query required: false schema: type: number - 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 MPFS fee schedule for cpt codes content: application/json: example: medicareFeeValues: RVU_FACILITY: TC_FEE: - fee: 0 feeLabel: WORK RVU - fee: 0.7463 feeLabel: PE RVU - fee: 0.00748 feeLabel: Malpractice RVU - fee: 0.75378 feeLabel: Total RVU PROF_FEE: - fee: 0.23 feeLabel: WORK RVU - fee: 0.07024 feeLabel: PE RVU - fee: 0.00748 feeLabel: Malpractice RVU - fee: 0.30772 feeLabel: Total RVU NATIONAL: - fee: 0.23 feeLabel: WORK RVU - fee: 0.93 feeLabel: PE RVU - fee: 0.02 feeLabel: Malpractice RVU - fee: 1.18 feeLabel: Total RVU LOCALITY: - fee: 0.23 feeLabel: WORK RVU - fee: 0.81654 feeLabel: PE RVU - fee: 0.01496 feeLabel: Malpractice RVU - fee: 1.0615 feeLabel: Total RVU RVU_OPPS: TC_FEE: - fee: 0 feeLabel: WORK RVU - fee: 2.73936 feeLabel: PE RVU - fee: 0.02992 feeLabel: Malpractice RVU - fee: 2.76928 feeLabel: Total RVU PROF_FEE: - fee: 0.23 feeLabel: WORK RVU - fee: 0.07024 feeLabel: PE RVU - fee: 0.00748 feeLabel: Malpractice RVU - fee: 0.30772 feeLabel: Total RVU NATIONAL: - fee: 0.23 feeLabel: WORK RVU - fee: 3.2 feeLabel: PE RVU - fee: 0.05 feeLabel: Malpractice RVU - fee: 3.48 feeLabel: Total RVU LOCALITY: - fee: 0.23 feeLabel: WORK RVU - fee: 2.8096 feeLabel: PE RVU - fee: 0.0374 feeLabel: Malpractice RVU - fee: 3.077 feeLabel: Total RVU RVU_NON_FACILITY: TC_FEE: - fee: 0 feeLabel: WORK RVU - fee: 0.7463 feeLabel: PE RVU - fee: 0.00748 feeLabel: Malpractice RVU - fee: 0.75378 feeLabel: Total RVU PROF_FEE: - fee: 0.23 feeLabel: WORK RVU - fee: 0.07024 feeLabel: PE RVU - fee: 0.00748 feeLabel: Malpractice RVU - fee: 0.30772 feeLabel: Total RVU NATIONAL: - fee: 0.23 feeLabel: WORK RVU - fee: 0.93 feeLabel: PE RVU - fee: 0.02 feeLabel: Malpractice RVU - fee: 1.18 feeLabel: Total RVU LOCALITY: - fee: 0.23 feeLabel: WORK RVU - fee: 0.81654 feeLabel: PE RVU - fee: 0.01496 feeLabel: Malpractice RVU - fee: 1.0615 feeLabel: Total RVU TOTAL_FEES: TC_FEE: - fee: 25.543493616 feeLabel: Facility - fee: 25.543493616 feeLabel: Non-Facility - fee: 93.843145216 feeLabel: OPPS Global PROF_FEE: - fee: 10.427769184 feeLabel: Facility - fee: 10.427769184 feeLabel: Non-Facility - fee: 10.427769184 feeLabel: OPPS Global NATIONAL: - fee: 39.986896 feeLabel: Facility - fee: 39.986896 feeLabel: Non-Facility - fee: 117.927456 feeLabel: OPPS Global LOCALITY: - fee: 35.9712628 feeLabel: Facility - fee: 35.9712628 feeLabel: Non-Facility - fee: 104.2709144 feeLabel: OPPS Global '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/mpfs/fee-schedule/i9v1/A4562/10112/00 '500': description: Interal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/fee-schedule/cpt/72072/10112/00 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/fee-schedule/mpfs-reduction-groups/hcpcs/{code}: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS reduction groups applicable for particular code operationId: getHcpcsMedicareReductionGroups parameters: - name: code in: path required: true schema: type: string example: A4562 - 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: - reductionLabel: Sequestration mpfsReductionGroupId: 13 nonFacTotalAdjFactor: 98.4 facTotalAdjFactor: 98.4 '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/mpfs/fee-schedule/mpfs-reduction-groups/i9v1/A4562 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/fee-schedule/mpfs-reduction-groups/hcpcs/A4562 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/mpfs/fee-schedule/mpfs-reduction-groups/cpt/{code}: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS Reduction Groups applicable for particular code operationId: getCptMedicareReductionGroups parameters: - name: code in: path required: true schema: type: string example: 99213 - 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 MPFS Reduction Groups applicable for cpt code content: application/json: example: - reductionLabel: FX Modifier Reduction mpfsReductionGroupId: 21 nonFacTotalAdjFactor: 80 facTotalAdjFactor: 80 - reductionLabel: FY Modifier Reduction mpfsReductionGroupId: 22 nonFacTotalAdjFactor: 93 facTotalAdjFactor: 93 - reductionLabel: Sequestration mpfsReductionGroupId: 13 nonFacTotalAdjFactor: 98.4 facTotalAdjFactor: 98.4 '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/mpfs/fee-schedule/mpfs-reduction-groups/i9v1/A4562 '500': description: Internal server error content: application/json: example: timestamp: '2023-07-13T06:36:22.518+00:00' path: /cmscommonms/api/cms/physician/mpfs/fee-schedule/mpfs-reduction-groups/hcpcs/A4562 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/cci/{market-type}/print: get: tags: - CCI Edits APIs summary: Physician - Prints CCI Edits for multi code operationId: printCCIResults parameters: - name: market-type in: path required: true schema: type: string enum: - non-facility - facility - 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: viewType in: query description: Any of these view types (Conflict or Code) are allowed Types, default is Conflict Type required: false schema: type: string enum: - Conflict - Code example: Conflict - name: isMpfs in: query required: false schema: type: boolean default: true example: 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: OK content: '*/*': schema: type: string format: byte security: - bearerAuth: [] /api/cms/physician/cci/{market-type}/conflict-view: get: tags: - CCI Edits APIs summary: Physician - Fecth CCI edits for multi code conflict view operationId: getMultiCodeConflictView parameters: - name: market-type in: path required: true schema: type: string enum: - non-facility - facility - 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: 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, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encount reason: Misuse of column two code with column one code modifier: Allowed workRVU: 1.92 nfPERVU: 1.79 nfTotalRVU: 3.85 malpracticeRVU: 0.14 nfTotalFee: 126.07 feeType: Non Facility priSecText: Primary - code: '99213' description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter fo reason: Misuse of column two code with column one code modifier: Allowed workRVU: 1.3 nfPERVU: 1.33 nfTotalRVU: 2.73 malpracticeRVU: 0.1 nfTotalFee: 89.39 feeType: Non Facility priSecText: Secondary '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/cciii '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /cmscommonms/api/cms/cci status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/cci/{market-type}/code-view: get: tags: - CCI Edits APIs summary: Physician - Fecth CCI Edits for multi code Code View operationId: getMultiCodeCodeView parameters: - name: market-type in: path required: true schema: type: string enum: - non-facility - facility - 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: Fecth CCI Edits for CodeView content: application/json: example: - code: '99213' cciEditsList: - - code: '13152' description: Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm reason: CPT Manual or CMS manual coding instructions modifier: '1' workRVU: 5.34 faPERVU: 3.95 faTotalRVU: 9.94 malpracticeRVU: 0.65 faTotalFee: 336.84 feeType: Facility priSecText: Primary - code: '99213' description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of reason: CPT Manual or CMS manual coding instructions modifier: '1' workRVU: 1.3 faPERVU: 0.55 faTotalRVU: 1.95 malpracticeRVU: 0.1 faTotalFee: 66.08 feeType: Facility priSecText: Secondary - - code: '99215' description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of reason: Misuse of column two code with column one code modifier: '1' workRVU: 2.8 faPERVU: 1.23 faTotalRVU: 4.23 malpracticeRVU: 0.2 faTotalFee: 143.34 feeType: Facility priSecText: Primary - code: '99213' description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of reason: Misuse of column two code with column one code modifier: '1' workRVU: 1.3 faPERVU: 0.55 faTotalRVU: 1.95 malpracticeRVU: 0.1 faTotalFee: 66.08 feeType: Facility priSecText: Secondary '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/cciii '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /cmscommonms/api/cms/cci status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/cms/physician/cci/{code}/{column-type}: get: tags: - CCI Edits APIs summary: Physician - Fetch CCI Edits for single code operationId: getSingleCodeView 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,reason,-reason,modifier,-modifier) 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 CCI edits for single code content: application/json: example: content: - code: '20560' description: Needle insertion(s) without injection(s); 1 or 2 muscle(s) reason: CPT Manual or CMS manual coding instructions modifier: Allowed workRVU: 0.32 nfPERVU: 0.44 faPERVU: 0.11 nfTotalRVU: 0.77 faTotalRVU: 0.44 malpracticeRVU: 0.01 nfTotalFee: 26.093144 faTotalFee: 14.910368 - code: '20561' description: Needle insertion(s) without injection(s); 3 or more muscles reason: CPT Manual or CMS manual coding instructions modifier: Allowed workRVU: 0.48 nfPERVU: 0.62 faPERVU: 0.16 nfTotalRVU: 1.12 faTotalRVU: 0.66 malpracticeRVU: 0.02 nfTotalFee: 37.953664 faTotalFee: 22.365552 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/cciii '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /cmscommonms/api/cms/cci status: 500 error: Internal Server Error requestId: e36d239e-324 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