openapi: 3.2.0
info:
  title: Optum DME and PEN Fee Schedule APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged DME and PEN Fee Schedule APIs across 2 of this provider''s published API definitions: optum-cms-common-facility-openapi.yml, optum-cms-common-physician-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: /v1/cmscommonms
tags:
- name: DME and PEN Fee Schedule APIs
paths:
  /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: []
    servers:
    - url: /v1/cmscommonms
  /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: []
    servers:
    - url: /v1/cmscommonms
  /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: []
    servers:
    - url: /v1/cmscommonms
components:
  schemas:
    Notification:
      type: object
      properties:
        error:
          type: array
          items:
            type: string
        warning:
          type: array
          items:
            type: string
        info:
          type: array
          items:
            type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-refined-from:
- optum-cms-common-facility-openapi.yml
- optum-cms-common-physician-openapi.yml
x-readme:
  explorer-enabled: true
  proxy-enabled: true