openapi: 3.0.1 info: title: Optum Common Facility description: MicroService that contains Optum module-related information contact: name: Ken Kracker email: ken.kracker@optum.com version: v1.0 servers: - url: /v1/optumcommonms paths: /app/optum/facility/claim/update: put: tags: - Facility Compliance APIs summary: Update the claim operationId: updateClaim parameters: - 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/FacilityClaimUpdate' required: true responses: '200': description: OK content: '*/*': schema: type: string security: - bearerAuth: [] /app/optum/facility/claim/update-claim-line: put: tags: - Facility Compliance APIs summary: Update the claim line operationId: updateClaimLine parameters: - 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/FacilityClaimUpdate' required: true responses: '200': description: OK content: '*/*': schema: type: string security: - bearerAuth: [] /app/optum/facility/claim/update-claim-diagnosis: put: tags: - Facility Compliance APIs summary: Update the claim diagnosis operationId: updateClaimDiagnosis parameters: - 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/FacilityClaimUpdate' required: true responses: '200': description: OK content: '*/*': schema: type: string security: - bearerAuth: [] /app/optum/facility/claim/submit/{compliance-type}/{scenario-number}: post: tags: - Facility Compliance APIs summary: Submit claim operationId: submitClaim parameters: - name: compliance-type in: path required: true schema: type: integer format: int32 - name: scenario-number in: path required: true schema: type: integer format: int32 - name: moduleId in: query required: true schema: type: string enum: - '106' - '105' - 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/FacilityClaimResponse' security: - bearerAuth: [] /app/optum/facility/claim/reset: post: tags: - Facility Compliance APIs summary: Reset claim operationId: resetClaim parameters: - 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/FacilityClaim' required: true responses: '200': description: OK content: '*/*': schema: type: integer format: int64 security: - bearerAuth: [] /app/optum/facility/claim/create: post: tags: - Facility Compliance APIs summary: Inserts a new claim operationId: createClaim parameters: - 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/FacilityClaim' required: true responses: '200': description: OK content: '*/*': schema: type: integer format: int64 security: - bearerAuth: [] /app/optum/facility/claim/create-claim-line: post: tags: - Facility Compliance APIs summary: Inserts a new claim line operationId: createClaimLine parameters: - 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/FacilityClaimLine' required: true responses: '200': description: OK content: '*/*': schema: type: integer format: int64 security: - bearerAuth: [] /app/optum/facility/claim/create-claim-diagnosis: post: tags: - Facility Compliance APIs summary: Inserts a new claim diagnosis operationId: createClaimDiagnosis parameters: - 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/FacilityClaimDiag' required: true responses: '200': description: OK content: '*/*': schema: type: string security: - bearerAuth: [] /api/optum/facility/outpatient-claims/: post: tags: - APC Calculator APIs summary: Fetches the data of APC calculator operationId: outpatientClaims parameters: - 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/ApcCalculatorRequest' required: true responses: '200': description: 'POST: Fetches APC calculator ' content: application/json: example: provider: '010001' fromDateStr: '2024-06-27' thruDateStr: '2024-06-27' gender: M age: '40' zipCode: '' dxCode: I10 dxCodeType: icd10 tobCode: '0131' conditionCode: '' claimLineList: - cptHcpcs: '99213' unit: '1' revCode: 0278 modifiers: '' dateStr: '2024-06-27' charge: '100' '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: /optumcommonms/outpatient-claims '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /optumcommonms/outpatient-claims/ status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/facility/federal-reg-add-b-history: post: tags: - Federal Register Addendum B History API summary: Fetches the data of federal register addendum B history operationId: getFederalRegAddBHistoryList parameters: - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these values (code, -code) are allowed.The default is code required: false schema: type: array items: type: string default: - code - 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/FederalRegAddBHistoryRequest' responses: '200': description: 'POST: Api for fetching the list of federal register addendum B history' content: application/json: example: content: - code: 0001A description: Adm sarscov2 30mcg/0.3ml 1st opsiQ1: E1 opsiQ2: E1 opsiQ3: E1 opsiQ4: E1 year: '2024' - code: 0011A description: Adm sarscov2 100mcg/0.5ml1st opsiQ1: E1 opsiQ2: E1 opsiQ3: E1 opsiQ4: E1 year: '2024' - code: 0021A description: Adm sarscov2 5x1010vp/.5ml 1 opsiQ1: E1 opsiQ2: E1 opsiQ3: E1 opsiQ4: E1 year: '2024' - code: 0031A description: Adm sarscov2 vac ad26 .5ml opsiQ1: E1 opsiQ2: E1 opsiQ3: E1 opsiQ4: E1 year: '2024' - code: 0041A description: Adm sarscov2 5mcg/0.5ml 1st opsiQ1: S relWeightQ1: '.4851' paymentQ1: '41.52' opsiQ2: S relWeightQ2: '.4851' paymentQ2: '41.52' opsiQ3: S relWeightQ3: '.4851' paymentQ3: '41.52' opsiQ4: S relWeightQ4: '.4851' paymentQ4: '41.52' year: '2024' - code: 0061A description: Fee covid-19 vac 7 dose 1 opsiQ1: E1 opsiQ2: D opsiQ3: D opsiQ4: D year: '2024' - code: 0091A description: Adm sarscov2 50 mcg/.5 ml1st opsiQ1: E1 opsiQ2: E1 opsiQ3: E1 opsiQ4: E1 year: '2024' - code: 0101A description: Fee covid-19 vac 11 dose 1 opsiQ1: E1 opsiQ2: D opsiQ3: D opsiQ4: D year: '2024' - code: 0111A description: Adm sarscov2 25mcg/0.25ml1st opsiQ1: E1 opsiQ2: E1 opsiQ3: E1 opsiQ4: E1 year: '2024' totalCount: 9 '400': description: Bad request content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - sort parameter value should be from list of [code,-code] warning: null info: null '404': description: Not found content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2024-11-18T06:37:03.741+00:00' status: 404 error: Not Found message: Not Found path: optumcommonms/api/optum/facility/federal-reg-add-b-historyyy '500': description: Interal server error content: application/json: example: timestamp: '2024-11-18T06:36:22.518+00:00' path: optumcommonms/api/optum/facility/federal-reg-add-b-history status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/facility/drg-calculator/: post: tags: - DRG Calculator APIs summary: Fetches the data of DRG calculator operationId: calculateDrg parameters: - 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/DrgCalculatorRequest' required: true responses: '200': description: 'POST: Fetch DRG calculator ' content: application/json: example: providerId: '010001' drgCode: '024' admitDate: '2023-01-23' disChargeDate: '2023-02-24' '400': description: Bad request content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - 'drgCalculatorRequest : Invalid date format. Please use yyyy-MM-dd format.' 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: api/optum/facility/drg-calculator '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /api/optum/facility/drg-calculator/ status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/common/physician/compliance/abn-form: post: tags: - Compliance APIs operationId: getABNForm parameters: - 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/ABNForm' required: true responses: '200': description: OK content: '*/*': schema: type: string format: byte security: - bearerAuth: [] /api/optum/common/cross-coder/list/hcpcs/{code}/i10_cm: post: tags: - Cross Coder API summary: Fetches cross coder table data operationId: getCrossCoderDataListI10CM parameters: - name: code in: path required: true schema: type: string example: K0001 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these (code,-code, description, -description) 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 requestBody: content: application/json: schema: $ref: '#/components/schemas/CrossCodesRequest' required: true responses: '200': description: Fetch columns for cross coder I10cm tab content: application/json: example: content: - code: G43.001 rangeCodeType: 0 codeType: 0 description: Migraine without aura, not intractable, with status migrainosus baseUnitValue: 0 source: Subject-Matter Expert Assigned associatedCodeLinkList: [] - code: G43.009 rangeCodeType: 0 codeType: 0 description: Migraine without aura, not intractable, without status migrainosus baseUnitValue: 0 associatedCodeLinkList: - value: A56273 href: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56273&ver=26&bc=0 totalCount: 2 ncw: false '400': description: Bad Request content: application/json: example: error: - sort parameter value should be from list of [code, description] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.UnsupportedOperationException: Unsupported codetype in Method getFindListQuery.' path: /optumcommonms/api/optum/facility/cross-coder/list security: - bearerAuth: [] /api/optum/common/cross-coder/list/cpt/{code}/i10_cm: post: tags: - Cross Coder API summary: Fetches Cross Coder table data operationId: getCrossCoderDataListI10CMFromCPT parameters: - name: code in: path required: true schema: type: string example: 17000 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these (code,-code, description, -description, primaryVol, -primaryVol, secondaryVol, -secondaryVol, tertiaryVol, -tertiaryVol, associatedCodeLinkList, -associatedCodeLinkList, isSme, -isSme) are allowed values. required: false schema: type: array items: type: string - 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 requestBody: content: application/json: schema: $ref: '#/components/schemas/CrossCodesRequest' required: true responses: '200': description: Fetch Columns for Cross Coder I10cm tab content: application/json: example: content: - code: G43.001 rangeCodeType: 0 codeType: 0 description: Migraine without aura, not intractable, with status migrainosus baseUnitValue: 0 source: Subject-Matter Expert Assigned associatedCodeLinkList: [] - code: G43.009 rangeCodeType: 0 codeType: 0 description: Migraine without aura, not intractable, without status migrainosus baseUnitValue: 0 associatedCodeLinkList: - value: A56273 href: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56273&ver=26&bc=0 totalCount: 2 ncw: false '400': description: Bad Request content: application/json: example: error: - sort parameter value should be from list of [code, description] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.UnsupportedOperationException: Unsupported codetype in Method getFindListQuery.' path: /optumcommonms/api/optum/facility/cross-coder/list security: - bearerAuth: [] /app/optum/facility/claim/details/{compliance-type}/{scenario-number}: get: tags: - Facility Compliance APIs summary: Get claim operationId: getClaim parameters: - name: compliance-type in: path required: true schema: type: integer format: int32 - name: scenario-number in: path required: true schema: type: integer format: int32 - name: moduleId in: query required: true schema: type: string enum: - '106' - '105' - 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/FacilityClaim' security: - bearerAuth: [] /app/optum/facility/claim/abn/{scenario-number}: get: tags: - Facility Compliance APIs summary: Get applicable codes for ABN operationId: getAbnCodes parameters: - name: scenario-number in: path required: true schema: type: integer format: int32 - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: OK content: '*/*': schema: type: array items: $ref: '#/components/schemas/Code' security: - bearerAuth: [] /api/optum/facility/{docId}/mdc-optimizing-tips-download: get: tags: - MDC Optimizing Tips APIs summary: Fetches the file content for MDC optimization tips operationId: getMDCOptimizingTipsDocument parameters: - name: docId in: path description: MDC Optimization Document ID required: true schema: type: integer format: int32 example: 492768 - 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 \ncache-control: no-cache,no-store,max-age=0,must-revalidate\ \ \nconnection: keep-alive \ncontent-disposition: attachment; filename=MDC_PRE \ncontent-encoding:\ \ gzip \ncontent-type: application/pdf \ndate: Fri,13 Sep 2024 13:02:20 GMT \nexpires:\ \ 0 \npragma: no-cache \ntransfer-encoding: chunked \nvary: Origin,Access-Control-Request-Method,Access-Control-Request-Headers\ \ \nx-content-type-options: nosniff \nx-frame-options: DENY \nx-xss-protection: 0 \n" '404': description: 'Not found: Sub terms not found' content: application/json: schema: $ref: '#/components/schemas/Notification' example: "{\n \"timestamp\": \"2023-07-28T06:19:48.666+00:00\",\n \"status\": 404,\n\ \ \"error\": \"Not Found\",\n \"message\": \"{\n \"error\": [\n\ \ \"No Data Found.\"\n ],\n \ \ \"warning\": null,\n \"info\": null\n }\",\n \ \ \"path\": \"/optumcommonms/api/optum/facility/13131313/mdc-optimizing-tips-download\"\ \n}" '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:19:48.666+00:00' path: optumcommonms/api/optum/facility/492768/mdc-optimizing-tips-download status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/optum/facility/{codetype}/cdg: get: tags: - Coding Documentation Guideline APIs summary: Fetches the list of clinical documentation guidelines operationId: fetchCDGList parameters: - name: codetype in: path required: true schema: type: string enum: - i9v1 - i9v3 - i10_cm - i10_pcs - hcpcs - cpt - 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 list of clinical documentation guidelines content: application/json: example: - rangeBegCode: '001' rangeEndCode: '139.8' rangeHeader: 1. Infectious And Parasitic Diseases (001-139) cdgInfoList: - code: '003.0' fullDescription: Salmonella gastroenteritis cdgAttachmentId: 59275 - code: '005.0' fullDescription: Staphylococcal food poisoning cdgAttachmentId: 59275 '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: /optumcommonms/api/optum/facility/cdeg '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /optumcommonms/api/optum/facility/cdg status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/facility/wage-index: get: tags: - Wage Index API summary: Fetches wage index list operationId: getWageIndexList 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: filter in: query description: Filter considers provider number and provider name, The provider number will be start match and provider name will be any match 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 wage index list content: application/json: example: content: - providerNumber: '010001' providerName: SOUTHEAST HEALTH MEDICAL state: Alabama wageIndexQ1: '0.8573' wageIndexQ2: '0.8573' wageIndexQ3: '0.8573' wageIndexQ4: '0.8573' year: '2024' - providerNumber: '010001' providerName: SOUTHEAST HEALTH MEDICAL state: Alabama wageIndexQ1: '0.8213' wageIndexQ2: '0.8213' wageIndexQ3: '0.8213' year: '2023' totalCount: 2 '400': description: Bad request content: application/json: example: error: - 'filter : length must be between 2 and 180' warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2024-11-05T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/wage-index?page=-1 security: - bearerAuth: [] /api/optum/facility/ub04/{codetype}/list: get: tags: - UB04 Code Lists summary: Fetches the list of UB04 codes on codetype operationId: getUb04Codes 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: codetype in: path description: UB04 Code Type required: true schema: type: string enum: - value-codes - occurrence-date-codes - condition-codes - occurrence-span-codes - 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/OptumPageImplCode' security: - bearerAuth: [] /api/optum/facility/revenue-procedure-cross-codes/{rev-code}: get: tags: - Revenue Codes API summary: Fetches procedure codes for corresponding revenue code operationId: getProcCodesForRevenueCode parameters: - name: rev-code in: path description: Revenue Code required: true schema: type: string example: '0250' - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these values (code,-code) are allowed. required: false schema: type: array items: type: string default: - code - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetches procedure codes for corresponding revenue code content: application/json: example: content: - code: A9270 description: Noncovered item or service tobCode: '012' tobDescription: Hospital Inpatient (Medicare Part B only) note: 'For Medicare claims: This code may be used for items and services associated with an ABN that do not have specific HCPCS codes assigned. Report under any appropriate revenue code. Other payers: This code is by definition a noncovered item or service.' codeType: hcpcs - code: A9270 description: Noncovered item or service tobCode: '013' tobDescription: Hospital Outpatient note: 'For Medicare claims: This code may be used for items and services associated with an ABN that do not have specific HCPCS codes assigned. Report under any appropriate revenue code. Other payers: This code is by definition a noncovered item or service.' codeType: hcpcs totalCount: 2 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, -code] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/revenue-procedure-cross-codes/0255?page=-1 security: - bearerAuth: [] /api/optum/facility/provider-lookup/{careSetting}: get: tags: - Provider Lookup APIs summary: Fetches outpatient provider lookup table data operationId: getLookupTableData parameters: - name: careSetting in: path required: true schema: type: string enum: - outpatient - inpatient - 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 (providerNumber,-providerNumber) are allowed. required: false schema: type: array items: type: string default: - providerNumber - 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 columns for lookup table content: application/json: example: content: - providerNumber: '010001' providerName: SOUTHEAST HEALTH MEDICAL state: AL - providerNumber: '010005' providerName: MARSHALL MEDICAL CENTERS state: AL - providerNumber: '010006' providerName: NORTH ALABAMA MEDICAL CEN state: AL totalCount: 7005 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [providerNumber, -providerNumber] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /cmscommonms/api/optum/facility/provider-lookup/outpatient security: - bearerAuth: [] /api/optum/facility/procedure-revenue-codes/{cpt-hcpcs-code}: get: tags: - Revenue Codes API summary: Fetches revenue codes for corresponding procedure code operationId: getRevenueCodesForProcCode parameters: - name: cpt-hcpcs-code in: path description: Cpt or HCPCS Code required: true schema: type: string example: 99213 - 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 (revenueCode,-revenueCode,tobCode,-tobCode) are allowed. required: false schema: type: array items: type: string default: - revenueCode - 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 revenue codes for corresponding procedure code content: application/json: example: content: - revenueCode: '0456' revenueCodeDesc: Emergency Room-Urgent Care tobCode: '013' tobCodeDesc: Hospital Outpatient note: Clinic or ED Visit. Paid a separate APC. - revenueCode: '0510' revenueCodeDesc: Clinic-General classification tobCode: '013' tobCodeDesc: Hospital Outpatient note: Clinic or ED Visit. Paid a separate APC. totalCount: 2 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [revenueCode, -revenueCode, tobCode, -tobCode] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/procedure-revenue-codes/99213?page=-1 security: - bearerAuth: [] /api/optum/facility/opsi-codes: get: tags: - OPSI Codes APIs summary: Fetches the list of OPSI codes operationId: fetchOpsiCodesList parameters: - name: sort in: query description: Any of these values (code , -code) are allowed.The default is code required: false schema: type: array items: type: string default: - code - name: limit in: query required: false schema: type: integer format: int32 default: 50 example: 150 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetches the list of OPSI codes content: application/json: example: content: - code: A opsiCodeId: '1' opsiCodeLink: value: A href: /api/optum/facility/opsi-codes/codes-associated-with-opsi/A/1 description: DMEPOS Fee Schedule paymentStatus: DMEPOS Fee Schedule paymentCalculation: DMEPOS fee schedule for the specific area. tips: Non-implantable prosthetics, and orthotics can be billed to the fiscal intermediary by hospitals and are paid under the DMEPOS fee schedule. - code: A opsiCodeId: '2' opsiCodeLink: value: A href: /api/optum/facility/opsi-codes/codes-associated-with-opsi/A/2 description: Physical, Occupational and Speech Therapy paymentStatus: Physician Fee Schedule paymentCalculation: MAC-specific fee schedule. '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: /optumcommonms/api/optum/facility/opsi-code '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /optumcommonms/api/optum/facility/opsi-codes status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/facility/opsi-codes/quarters/{code}: get: tags: - OPSI Codes APIs summary: Fetches the list of OPSI hac quarters for CPT HCPS code operationId: fetchOpsiCodeQuarterList 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 the list of OPSI hac quarters for CPT HCPCS code content: application/json: example: - code: B year: 2025-1 - code: B year: 2024-4 - code: B year: 2024-3 - code: B year: 2024-2 '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: optumcommonms/api/optum/facility/opsi-codes/quarter/99213 '500': description: Internal server error content: application/json: example: timestamp: '2025-01-10T06:36:22.518+00:00' path: optumcommonms/api/optum/facility/opsi-codes/quarters/99213 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/facility/opsi-codes/codes-associated-with-opsi/{opsi-code}/{opsi-code-id}: get: tags: - OPSI Codes APIs summary: Fetches the list of cpt or hcpcs code associated with particular OPSI Code operationId: fetchOpsiCodesList_1 parameters: - name: opsi-code-id in: path required: true schema: type: string example: 1 - name: opsi-code in: path required: true schema: type: string example: A - name: sort in: query description: Any of these values (code , -code) are allowed.The default is code required: false schema: type: array items: type: string default: - code - name: limit in: query required: false schema: type: integer format: int32 default: 50 example: 150 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: 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 list of cpt or hcpcs code associated with particular OPSI code content: application/json: example: content: - code: 0001F description: 'Heart failure assessed (includes assessment of all the following components) (CAD): Blood pressure measured (2000F) Level of activity assessed (1003F) Clinical symptoms of volume overload (excess) assessed (1004F) Weight, recorded (2001F) Clinical signs of volume overload (excess) assessed (2002F)' title: Non-Covered Items and Services based on Statutory exclusions, Not covered by any Medicare outpatient benefit category, Not reasonable and necessary - code: 0005F description: 'Osteoarthritis assessed (OA) Includes assessment of all the following components: Osteoarthritis symptoms and functional status assessed (1006F) Use of anti-inflammatory or over-the-counter (OTC) analgesic medications assessed (1007F) Initial examination of the involved joint(s) (includes visual inspection, palpation, range of motion) (2004F)' title: Non-Covered Items and Services based on Statutory exclusions, Not covered by any Medicare outpatient benefit category, Not reasonable and necessary '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: /optumcommonms/api/optum/facility/opsi-code/codes-associated-with-opsi/A/1/ '500': description: Interal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /optumcommonms/api/optum/facility/opsi-code/codes-associated-with-opsi/A/1 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/facility/opps-cross-codes: get: tags: - Opps Cross Codes API summary: Fetches OPPS cross codes table data operationId: getOppsCrossCodesList parameters: - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these (code,-code) are allowed values. required: false schema: type: array items: type: string default: - code - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetch columns for OPPS cross codes content: application/json: example: content: - code: 0734T description: Remote real-time, motion capture-based neurorehabilitative therapy ordered by a physician or other qualified health care professional; treatment management services by a physician or other qualified health care professional, per calendar month referenceCodes: 99457-99458 effectiveDate: '2022-07-01 00:00:00' - code: '52441' description: Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant referenceCodes: C9739 effectiveDate: '2015-01-01 00:00:00' totalCount: 132 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, -code] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/opps-cross-codes security: - bearerAuth: [] /api/optum/facility/national-charge-data: get: tags: - National Charge Data API summary: Fetches national charge data table data operationId: getNationalChargeData parameters: - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these values (code,-code) are allowed. required: false schema: type: array items: type: string default: - code - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetch columns for national percentage charge data content: application/json: example: content: - code: 0001U description: Red blood cell antigen typing, DNA, human erythrocyte antigen gene analysis of 35 antigens from 11 blood groups, utilizing whole blood, common RBC alleles reported opsiCode: A nationalVolume: '152.0' percentile10: '751.0' percentile25: '887.0' median: '1385.0' percentile75: '1440.0' percentile90: '1440.0' calendarYear: '2023' - code: '00520' description: Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified opsiCode: N nationalVolume: '23254.0' percentile10: '64.0' percentile25: '64.0' median: '139.0' percentile75: '259.0' percentile90: '590.0' calendarYear: '2023' totalCount: 7005 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, -code] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /cmscommonms/api/optum/facility/national-charge-data security: - bearerAuth: [] /api/optum/facility/mdcOptimizingTips: get: tags: - MDC Optimizing Tips APIs summary: Fetches the MDC optimizing codes tips table data operationId: getMDCOptimizingTips parameters: - name: sort in: query description: Any of these values (mdcCode, -mdcCode, drgCode , -drgCode ) are allowed.The default is +drgCode required: false schema: type: array items: type: string default: - drgCode - name: limit in: query required: false schema: type: integer format: int32 default: 50 example: 150 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetch MDC optimizing tips table data content: application/json: example: content: - drgCode: '001' drgDescription: Heart Transplant or Implant of Heart Assist System with MCC optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: '002' drgDescription: Heart Transplant or Implant of Heart Assist System without MCC optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: '003' drgDescription: ECMO or Tracheostomy with Mechanical Ventilation >96 Hours or Principal Diagnosis Except Face, Mouth and Neck with Major O.R. Procedures optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: '004' drgDescription: Tracheostomy with Mechanical Ventilation >96 Hours or Principal Diagnosis Except Face, Mouth and Neck without Major O.R. Procedures optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: '005' drgDescription: Liver Transplant with MCC or Intestinal Transplant optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: '006' drgDescription: Liver Transplant without MCC optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: '007' drgDescription: Lung Transplant optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE - drgCode: 008 drgDescription: Simultaneous Pancreas and Kidney Transplant optimizingTipsId: '492768' mdcDescription: Pre MDC mdcCode: PRE totalCount: 8 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [mdcCode, -mdcCode, drgCode, -drgCode] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2024-07-25T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/mdcOptimizingTips?sort=drgCode&limit=150&page=-1&filter=18 security: - bearerAuth: [] /api/optum/facility/hcpcs-drugs: get: tags: - HCPCS Table of Drugs API summary: Fetches HCPCS drugs table data operationId: getHCPCSDrugsList 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: 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 HCPCS drugs data content: application/json: example: content: - code: J7100 drugName: 10% LMD unitPerMl: 500 ML route: IV - code: S5010 drugName: 5% DEXTROSE AND .45% NORMAL SALINE unitPerMl: 1000 ML route: IV totalCount: 3051 '400': description: Bad request content: application/json: example: error: - 'filter : length must be between 2 and 180' warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2024-11-05T22:34:37.080+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/hcpcs-drugs security: - bearerAuth: [] /api/optum/facility/federal-register-addendum-b: get: tags: - Federal Register Addendum B API summary: Fetches all federal register addendum B table data operationId: getFederalRegAddBList 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,opsiCode,-opsiCode,description,-description,apc,-apc) are allowed. required: false schema: type: array items: type: string default: - code - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetches all federal register addendum B table data content: application/json: example: content: - code: 0001F opsiCode: E1 description: HEART FAILURE COMPOSITE relWeight: 0 payRate: 0 natUnadjCopay: 0 minUnadjCopay: 0 - code: 0001U opsiCode: A description: RBC DNA HEA 35 AG 11 BLD GRP relWeight: 0 payRate: 0 natUnadjCopay: 0 minUnadjCopay: 0 totalCount: 18341 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, -code] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/federal-register-addendum-b?page=-1 security: - bearerAuth: [] /api/optum/facility/drg-indicators: get: tags: - Diagnostic Related Groups (DRG) Indicators APIs operationId: getDRGIndicatorList parameters: - name: sort in: query description: Any of these values (drgCode,-drgCode,mdcCode,-mdcCode) are allowed.The default is drgCode required: false schema: type: array items: type: string default: - drgCode - 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 DRG indicator list content: application/json: example: content: - drgId: '39806' drgCode: '014' drgDescription: Allogeneic Bone Marrow Transplant mdcCode: PRE mdcDescription: Pre MDC medSurg: M gmLos: '25.6' amLos: '28.7' relativeWeight: '11.4609' - drgId: '39757' drgCode: '987' drgDescription: Nonextensive O.R. Procedures Unrelated to Principal Diagnosis with MCC mdcCode: ALL mdcDescription: All MDC medSurg: S gmLos: '8.2' amLos: '11.4' relativeWeight: '3.3767' iconIds: DRG MCC,Special Payment totalCount: 2 '500': description: Internal server error content: application/json: example: timestamp: '2024-08-22T07:29:21.890+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page index must not be less than zero' path: /optumcommonms/api/optum/facility/drg-indicators security: - bearerAuth: [] /api/optum/facility/cpt-hcpcs-required-revenue: get: tags: - Revenue Codes API summary: Fetches revenue codes requiring CPT HCPCS operationId: getCptHcpcsRequiredRevenueCodes parameters: - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these values (code,-code) are allowed. required: false schema: type: array items: type: string default: - code - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetches revenue codes requiring CPT HCPCS content: application/json: example: content: - code: 0278 description: Medical/Surgical Supplies and Devices hasProcedureCodes: true rangeDescription: Ancillary Services subCategoryAbbr: SUPPLY/IMPLANTS subCategoryDes: Other Implants - code: 0291 description: Durable Medical Equipment (Other than renal) hasProcedureCodes: true rangeDescription: Ancillary Services subCategoryAbbr: DME-RENTAL subCategoryDes: Rental totalCount: 2 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, -code] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/cpt-hcpcs-required-revenue?page=-1 security: - bearerAuth: [] /api/optum/facility/cdg/{code}/document: get: tags: - Coding Documentation Guideline APIs summary: Fetches the file content for clinical coding guidelines operationId: fetchCDGPDF parameters: - name: code in: path description: code required: true schema: type: string example: '003.0' - 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=cdg22.pdf\n content-length:\ \ 254685\n content-type: application/pdf\n date: Thu,16 May 2024 06:49:56 GMT\n expires:\ \ 0\n pragma: no-cache\n vary: Origin,Access-Control-Request-Method,Access-Control-Request-Headers\n\ \ x-content-type-options: nosniff\n x-frame-options: DENY\n x-xss-protection: 0\n" '404': description: 'Not found: Sub terms not found' content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2023-07-28T06:19:48.666+00:00' status: 404 error: Not Found message: Not Found path: /optumcommonms/api/optum/facility/cdg/{code}d '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:19:48.666+00:00' path: /optumcommonms/api/optum/facility/cdg/{code}/document status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/optum/facility/all-revenue-codes: get: tags: - Revenue Codes API summary: Fetches all revenue codes table data operationId: getAllRevenueCodes parameters: - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: limit in: query required: false schema: type: integer format: int32 default: 50 - name: sort in: query description: Any of these values (code,-code) are allowed. required: false schema: type: array items: type: string default: - code - name: filter in: query required: false schema: type: string - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetches all revenue codes table data content: application/json: example: content: - code: '0000' description: Reserved hasProcedureCodes: false - code: '0001' description: Total Charges (reportable on paper claims only) hasProcedureCodes: false totalCount: 1232 '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, -code] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one' path: /optumcommonms/api/optum/facility/all-revenue-codes?page=-1 security: - bearerAuth: [] /api/optum/common/{contractor}/medicare-contractors: get: tags: - Compliance APIs summary: Fetches medicare contractors list for a given contractor Type. operationId: fetchMedicareContractors parameters: - name: sort in: query description: Any of these values (id, name) are allowed.The default is id required: false schema: type: array items: type: string default: - id - name: contractor in: path required: true schema: type: string enum: - physician - facility - 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/optum/common/{code}/{modifier-type}/{mod-code}/{prod-code}/modifier-download: get: tags: - Modifier CrossWalk API summary: Generates the pdf format file with the details of selected modifier code operationId: printModCodesReport parameters: - name: code in: path description: 'Cpt OR Hcpcs code ' required: true schema: type: string example: 99213 - name: modifier-type in: path required: true schema: type: string enum: - MPFS - DME - AMBULANCE - name: mod-code in: path description: 'modifier code ' required: true schema: type: string example: 24 - name: prod-code in: path description: Product code C/M i.e Commercial/ Medicare required: true schema: type: string example: M - 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: Generates the PDF and return the content in the format of byte array, response headers and media type as PDF 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=PHYSICIAN.pdf\ \ \n content-length: 3663 \n content-type: application/pdf \n date: Wed,26 Apr 2023 12:17:11\ \ GMT \n expires: 0 \n pragma: no-cache \n strict-transport-security: max-age=31536000\ \ ; includeSubDomains \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: 1;\ \ mode=block \n" '404': description: Not found- No Data Found. content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - No Data Found. warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-02-08T06:19:48.666+00:00' path: /optumcommonms/api/optum/common/99213/MPFS/24/M/modifier-download status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/optum/common/{code}/{modifier-type}/modifier-crosswalk: get: tags: - Modifier CrossWalk API summary: Returns the list of modifierCrosswalk based on the selected cpt or hcpcs code operationId: modifierCrosswalk parameters: - name: code in: path description: 'Cpt OR Hcpcs code ' required: true schema: type: string example: A4580 - name: modifier-type in: path required: true schema: type: string enum: - MPFS - DME - AMBULANCE - ASC - 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 available list of modifier crosswalk for the selected code content: application/json: example: content: - code: A4580 modifierCodeLink: value: '52' href: /api/coding/code/52/modifier-crosscodes description: Reduced Services usage: (Modifier 52 is used for surgical procedures and certain diagnostic procedures for whch anesthesia was not planned. Report this modifier when the procedure was discontinued after the patient was prepared and brought to the room where the procedure was to be performed. only.~Modifier is valid for reporting reduced radiology procedures.~When a radiology procedure is reduced, the correct reporting is to assign the CPT code to the extent of the procedure performed. This modifier is used only to report a radiology procedure that has been reduced when no other code exists to report what has been done. Report the intended code with modifier 52.~For example, if the planned procedure is a two-view chest x-ray and only one view of the chest is performed, do not report CPT code 71020-52 (for x-ray chest, two views-reduced service). Instead, report CPT code 71010 (x-ray chest, single view). If a barium swallow is not completed because the patient cannot handle the barium, report CPT code 74270-52.) definition: 'Under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. Note: For hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).' sourcingRationaleNum: 'Sourcing Rationale: 589' sourcingRationale: "Current Procedural Terminology (CPT) Level I modifiers and Healthcare\ \ Common Procedure Coding System (HCPCS) Level II modifiers are appended to Level\ \ I or Level II codes based on information from the Centers for Medicare and Medicaid\ \ Services (CMS). The identified modifiers are: the ambulance specific modifiers,\ \ 1P, 24, 25, 2P, 3P, 50, 51, 52, 54, 55, 56, 57, 58, 59, 76, 77, 78, 79, 8P, 90,\ \ 91, AA, AB, AD, AQ, AR, AT, AU, AV, AW, AX, AY, BA, BP, BR, BU, CD, CE, CF, CH,\ \ CI, CJ, CK, CL, CM, CN, CT, EA, EB, EC, EM, EY, G7-G9, GE, GG, GK, GL, GM, GN, GO,\ \ GP, GQ, GT, J4, KB, KC, KF, KI, KJ, KM, KN, KZ, LR, NR, NU, PI, PS, PT, Q7-Q9, QA,\ \ QB, QE, QF, QG, QK, QR, QS, QW, QX, QY, QZ, RR, UE, UN, UP, UQ, UR, US, VM, XE,\ \ XP, XS, XU, ZA, ZB,ZC. \r\nThe above identified CPT/HCPCS modifier to procedure\ \ relationships are supported by CMS information from the Medicare Claims Processing\ \ Manual, program transmittals, National Physician Fee Schedule (NPFS), Clinical Laboratory\ \ Fee Schedule, DME/PEN fee schedules, Ambulance fee schedule, and claims adjudication\ \ policies.\r\nModifiers that are covered by other Medicare rules; therefore are excluded\ \ from this rule are:\r\n22, 26, 62, 66, 80-82, AS, and TC.\r\nModifiers that do not\ \ have a specific national CMS source or a source that addresses specific codes that\ \ these modifiers should be appended to; therefore are excluded from this rule are:\r\ \n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r\nModifiers that have a coverage\ \ indicator of I, M, or S on the HCPCS file. These indicators state that they are\ \ noncovered or nonpayable by Medicare. These modifiers are excluded from this rule\ \ are:\r\nAZ, FB, GY, GZ, H9, HA-HZ, PA-PC, SA-SB, SD-SE, SH-SN, SQ, SS-SV, SY, TD-TH,\ \ TJ-TN, TP-TR, TT-TW, U1-U9, UA-UD, UF-UH and UK.\r\nModifiers that have facility\ \ related only national CMS sources; therefore are not included in this professional\ \ rule:\r\n27, 73, 74, BL, CA, ED, EE, ET, FC, G1-G6, GF, GS, JG, L1, Q2, QM, and\ \ QN." source: CMS Policy productCode: M commercialMedicare: Medicare totalCount: 43 '404': description: Not found. content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2023-03-27T12:23:36.422+00:00' status: 404 error: Not Found message: Not Found path: /optumcommonms/api/optum/common/A4580/test/modifier-crosswalk?limit=150&page=1 security: - bearerAuth: [] /api/optum/common/{code}/ndc: get: tags: - National Drug Code API summary: Fetches the national drug code table data operationId: fetchNationalDrugCodeList parameters: - name: code in: path required: true schema: type: string example: J0121 - name: page in: query required: false schema: type: integer format: int32 default: 1 - name: size in: query required: false schema: type: integer format: int32 default: 50 - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetch national drug code list content: application/json: example: content: - ndc: '71715000101' genericName: Omadacycline brandName: NUZYRA mfg: PARATEK PHARMACEUTICALS INC. - ndc: '71715000102' genericName: Omadacycline brandName: NUZYRA mfg: PARATEK PHARMACEUTICALS INC. totalCount: 2 '500': description: Internal server error content: application/json: example: timestamp: '2024-08-22T07:29:21.890+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.IllegalArgumentException: Page index must not be less than zero' path: /optumcommonms/api/optum/common/ndc/J0121 security: - bearerAuth: [] /api/optum/common/{codetype}/{code}/ccm: get: tags: - Consumer Code Manager API summary: Fetches the ConsumerInfo based on the codetype and code operationId: consumerInfo parameters: - name: codetype in: path required: true schema: type: string enum: - cpt - hcpcs - i10_cm - i10_pcs - 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: Fetch consumer info for given code and codetype content: application/json: example: ccmFull: Physician office visit. The amount of time with the physician is determined by a person's condition and treatment needs. ccmShort: Doctor's office visit ccmSpanish: Visita al consultorio médico '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 '500': description: Internal server error content: application/json: example: timestamp: '2022-07-06T07:22:01.017+00:00' path: /api/coding/code/i10_cm/D68.2/ccm status: 500 error: Internal Server Error requestId: a4796cc7-1 security: - bearerAuth: [] /api/optum/common/source-rationale: get: tags: - Compliance APIs summary: Get Source Rationale operationId: getSourceRationale parameters: - name: ddrId in: query required: false schema: type: string - name: mnemonic 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/PhysicianClaimSourceRationale' security: - bearerAuth: [] /api/optum/common/medicare-carrier-localities: get: tags: - Medicare Carrier Localities summary: Fetches medicare carrier 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 carrier 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: '2025-01-07T06:37:03.741+00:00' status: 404 error: Not Found message: Not Found path: /optumcommonms/api/optum/common/medicare-carrier-localities '500': description: Interal server error content: application/json: example: timestamp: '2025-01-07T06:36:22.518+00:00' path: /optumcommonms/api/optum/common/medicare-carrier-localities status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/common/get-policy-url/{contractror-id}/{policy-id}: get: tags: - Compliance APIs summary: Get Policy URL operationId: getPolicyURL parameters: - name: contractror-id in: path required: true schema: type: string - name: policy-id in: path required: true schema: type: string - name: from-date in: query required: true schema: type: string - name: to-date in: query 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: OK content: '*/*': schema: type: string security: - bearerAuth: [] /api/optum/common/cross-coder/list/{codetype}/{code}/{tab}: get: tags: - Cross Coder API summary: Fetches cross coder table data operationId: getCrossCoderDataList parameters: - name: code in: path required: true schema: type: string example: 17000 - name: codetype in: path required: true schema: type: string enum: - cpt - hcpcs - i10_pcs - i10_cm - i9v1 - i9v3 example: cpt - name: tab in: path required: true schema: type: string enum: - cpt - hcpcs - anesthesia_codes - i10_pcs - medicine_codes - dental example: hcpcs - 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, description, -description) 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 columns for cross coder content: application/json: example: content: - code: A9270 rangeCodeType: 0 codeType: 0 description: Noncovered item or service baseUnitValue: 0 - code: V2632 rangeCodeType: 0 codeType: 0 description: Posterior chamber intraocular lens baseUnitValue: 0 totalCount: 2 ncw: false '400': description: Bad request content: application/json: example: error: - sort parameter value should be from list of [code, description] warning: null info: null '500': description: Internal server error content: application/json: example: timestamp: '2023-07-27T08:10:07.573+00:00' status: 500 error: Internal Server Error message: 'Request processing failed: java.lang.UnsupportedOperationException: Unsupported codetype in Method getFindListQuery.' path: /optumcommonms/api/optum/facility/cross-coder/list security: - bearerAuth: [] /api/optum/common/compliance/place-of-service-codes: get: tags: - Compliance APIs operationId: getPlaceOfServiceCodes 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: OK content: '*/*': schema: type: array items: $ref: '#/components/schemas/PlaceOfServiceValue' security: - bearerAuth: [] /api/optum/common/code-specific-guidelines/{codetype}/article/{code}/{article-id}: get: tags: - Code Specific Guidelines APIs summary: Fetch current year code specific guidelines article operationId: fetchCodeSpecificArticle parameters: - name: code in: path description: Term/code search value required: true schema: type: string example: N17.9 - name: codetype in: path required: true schema: type: string enum: - i10_cm - i10_pcs example: i10_cm - name: article-id in: path required: true schema: type: string example: CGi10440125 - 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 current year code specific guidelines article content: application/json: example: "{\n \"year\": \"2025\",\n \"title\": \"Diseases of the Genitourinary System\"\ ,\n \"articleId\": \"CGi10440125\",\n \"article\": \"article details\",\n \"\ articleUpdate\": \"article update details\"\n \"quarter\": 0,\n \"sourceType\":\ \ \"CSG_CM\",\n \"code\": \"N17.9\",\n \"codeTypeId\": 16384\n}\n" '404': description: Not found. content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2025-07-11T12:23:36.422+00:00' status: 404 error: Not Found message: Not Found path: /api/optum/common/code-specific-guidelines/article '500': description: Internal server error content: application/json: example: "{\n \"timestamp\": \"2025-05-08T07:22:01.017+00:00\",\n \"path\": \"/api/optum/common/code-specific-guidelines/article/N17.9\"\ ,\n \"status\": 500,\n \"error\": \"Internal Server Error\",\n}" security: - bearerAuth: [] /api/optum/common/code-specific-guidelines/{codetype}/article-list/{code}: get: tags: - Code Specific Guidelines APIs summary: Fetch current year code specific guidelines articles list operationId: fetchCodeSpecificArticlesList 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: code in: path description: Term/code search value required: true schema: type: string example: I10 - name: codetype in: path required: true schema: type: string enum: - i10_cm - i10_pcs example: i10_cm - name: yyyy-MM-dd in: header description: Date for which historical data is required required: false schema: type: string format: yyyy-MM-dd responses: '200': description: Fetch current year code specific guidelines articles list content: application/json: example: - year: '2025' title: Diseases of the Genitourinary System articleId: CGi10440125 quarter: 0 sourceType: CSG_CM code: N17.9 codeTypeId: 16384 '404': description: Not found. content: application/json: schema: $ref: '#/components/schemas/Notification' example: timestamp: '2025-07-11T12:23:36.422+00:00' status: 404 error: Not Found message: Not Found path: /api/optum/common/code-specific-guidelines/i10_cm/article-list '500': description: Internal server error content: application/json: example: "{\n \"timestamp\": \"2025-05-08T07:22:01.017+00:00\",\n \"path\": \"/api/optum/common/code-specific-guidelines/i10_cm/article-list/E11.01\"\ ,\n \"status\": 500,\n \"error\": \"Internal Server Error\",\n}" security: - bearerAuth: [] /app/optum/facility/claim/delete/claim-line-edits: delete: tags: - Facility Compliance APIs summary: Delete claim line edits operationId: deleteClaimLineEdits parameters: - 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: type: array items: type: integer format: int32 required: true responses: '200': description: OK content: '*/*': schema: type: string security: - bearerAuth: [] /app/optum/facility/claim/delete-claim-line/{claim-line-id}: delete: tags: - Facility Compliance APIs summary: Delete the claim line operationId: deleteClaimLine parameters: - name: claim-line-id in: path required: true schema: type: integer format: int64 - 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 security: - bearerAuth: [] components: schemas: FacilityClaimUpdate: type: object properties: claimId: type: integer format: int64 claimLineId: type: integer format: int64 fieldName: type: string fieldValue: type: string FacilityClaimLineEdits: type: object properties: claimLineId: type: integer format: int32 editType: type: string mnemonic: type: string message: type: string claimLineNum: type: integer format: int32 FacilityClaimResponse: type: object properties: claimId: type: integer format: int64 patientUserId: type: integer format: int64 claimType: type: string enum: - PHYSICIAN - FACILITY edits: type: array items: $ref: '#/components/schemas/FacilityClaimLineEdits' FacilityClaim: type: object properties: claimId: type: integer format: int64 userId: type: integer format: int64 currentTimeStamp: type: string format: date-time tabNumber: type: integer format: int32 payerType: type: integer format: int32 contractorNum: type: string contractorSort: type: string medicaidState: type: string claimIdentifier: type: string typeOfBill: type: string statStartDate: type: string format: date-time statEndDate: type: string format: date-time patientDOB: type: string format: date-time patientGender: type: string patientStatus: type: string pointOfOrigin: type: string admissionDate: type: string format: date-time admissionType: type: string conditionCodes: type: string valueCodes: type: string occurrenceCodes: type: string occurrenceSpanCodes: type: string complianceType: type: integer format: int32 moduleId: type: string facilityClaimLineList: type: array items: $ref: '#/components/schemas/FacilityClaimLine' claimDiag: $ref: '#/components/schemas/FacilityClaimDiag' claimLineEditsList: type: array items: $ref: '#/components/schemas/FacilityClaimLineEdits' payer: type: string FacilityClaimDiag: type: object properties: claimId: type: integer format: int64 principalDx: type: string admitting: type: string others: type: string primary1Px: type: string primary1PxDate: type: string format: date-time primary2Px: type: string primary2PxDate: type: string format: date-time other1Px: type: string other1PxDate: type: string format: date-time other2Px: type: string other2PxDate: type: string format: date-time other3Px: type: string other3PxDate: type: string format: date-time other4Px: type: string other4PxDate: type: string format: date-time reasonForVisit: type: string ipAdmitting: type: string FacilityClaimLine: type: object properties: claimLineId: type: integer format: int32 claimId: type: integer format: int64 revenueCode: type: string procedureCode: type: string modifier: type: string lineNumber: type: integer format: int32 units: type: integer format: int32 dateOfService: type: string format: date-time ndc: type: string ApcCalculatorRequest: required: - dxCode - dxCodeType - fromDateStr - gender - provider - thruDateStr type: object properties: provider: maxLength: 2147483647 minLength: 1 type: string description: Terms to search for fromDateStr: type: string thruDateStr: type: string gender: pattern: ^([MFUI])$ type: string age: pattern: ^\d{1,3}$ type: string zipCode: pattern: ^(\d{1,5}|)$ type: string dxCode: type: string dxCodeType: pattern: ^(icd9|icd10)$ type: string tobCode: pattern: ^(.{0,4}|)$ type: string conditionCode: pattern: ^(.{1,2}|)$ type: string claimLineList: type: array items: $ref: '#/components/schemas/ClaimLine' ClaimLine: type: object properties: cptHcpcs: type: string unit: type: string revCode: type: string modifiers: type: string dateStr: type: string charge: type: string cptHcpcsDesc: type: string Notification: type: object properties: error: type: array items: type: string warning: type: array items: type: string info: type: array items: type: string FederalRegAddBHistoryRequest: type: object properties: code: type: string description: type: string year: type: string DrgCalculatorRequest: required: - admitDate - disChargeDate - drgCode - providerId type: object properties: providerId: type: string drgCode: type: string admitDate: type: string format: date-time disChargeDate: type: string format: date-time ABNForm: type: object properties: notifierName: type: string notifierAddress: type: string notifierPhone: type: string patientName: type: string patientIdentifier: type: string itemServices: type: array items: $ref: '#/components/schemas/ABNItemService' additionalInfo: type: string isEnglishPDF: type: boolean ABNItemService: type: object properties: codeItemService: type: string estimatedCost: type: string patientAction: type: string medicareNoPayReason: type: string spanishMedicareReason: type: string CrossCodesRequest: type: object properties: isLcdNcdData: type: string isSmeaData: type: string isClaimsData: type: string macType: type: string contractorId: type: string Code: type: object properties: codeValue: type: string description: type: string OptumPageImplCode: type: object properties: content: type: array items: $ref: '#/components/schemas/Code' totalCount: type: integer format: int64 ContractorValue: type: object properties: contractorNumber: type: string contractorName: type: string PhysicianClaimSourceRationale: type: object properties: ddrId: type: string mnemonic: type: string editMessage: type: string source: type: string editType: type: string sourceInfo: type: string sourceUrl: type: string description: type: string PlaceOfServiceValue: type: object properties: code: type: string description: type: string securitySchemes: bearerAuth: type: http scheme: bearer bearerFormat: JWT x-readme: explorer-enabled: true proxy-enabled: true