openapi: 3.0.1 info: title: Optum Common Physician 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/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/physician/{code}/coding-tips: get: tags: - Coding Tips API summary: Fetches the list of codingTips for CPT or HCPCS codes operationId: getCodingTips 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 codingTips for CPT or HCPCS codes content: application/json: example: - tipType: Coding Tips tip: Note that 38790 is a unilateral procedure. '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/physician/99213/coding-tips '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /optumcommonms/api/optum/physician/99213/coding-tips status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/physician/{code}/annotations: get: tags: - Coding Tips API summary: Fetches the list of annotations for HCPCS codes operationId: getAnnotations parameters: - name: code in: path required: true schema: type: string example: G0137 - 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 annotations for HCPCS codes content: application/json: example: content: - annotationType: Annotation annotationDescription: diagnostic services; - annotationType: DEF annotationDescription: Plaque deposits in natural heart vessels. 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: /optumcommonms/api/optum/physician/A2007/annotations '500': description: Internal server error content: application/json: example: timestamp: '2023-07-28T06:36:22.518+00:00' path: /optumcommonms/api/optum/physician/A2007/annotations status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/physician/mpfs/locality-fee/{codetype}/{code}/{carrier}/{locality}: get: tags: - Medicare Fee Schedule APIs summary: Fetches MPFS fee scedule operationId: fetchMedicareLocalityFees 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: Locality: - fee: 1.3 feeLabel: Work - fee: 1.97 feeLabel: Total RVU_NON_FACILITY: Locality: - fee: 1.3 feeLabel: Work - fee: 2.75 feeLabel: Total TOTAL_FEES: Locality: - fee: 63.722605 feeLabel: Facility - fee: 88.952875 feeLabel: Non-Facility conversionFactor: 32.3465 '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/optum/physician/mpfs/locality-fee/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/optum/physician/mpfs/locality-fee/cpt/72072/10112/00 status: 500 error: Internal Server Error requestId: e36d239e-324 security: - bearerAuth: [] /api/optum/physician/anesthesia-fee/{codetype}/{code}: get: tags: - Anesthesia Fee APIs summary: Fetches anesthesia fee carrier localities and units information for a given anesthesia code operationId: fetchAnesthesiaFee parameters: - name: codetype in: path required: true schema: type: string enum: - cpt - name: code in: path required: true schema: type: string example: '00100' - 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 anesthesia fee carrier localities and units information for a given anesthesia code content: application/json: example: anesCarrierLocalityList: - carrier: '10112' locality: '00' state: Alabama conversionFactor: '19.77' - carrier: '02102' locality: '01' state: Alaska conversionFactor: '28.54' anesPhysicalStatusUnitsList: - status: P1 description: A normal healthy patient units: 0 - status: P2 description: A patient with mild systemic disease units: 0 anesQualifyingCircumstancesUnitsList: - code: '99100 ' description: Anesthesia for patient of extreme age, younger than 1 year and older than 70 (List separately in addition to code for primary anesthesia procedure) units: 1 - code: '99116 ' description: Anesthesia complicated by utilization of total body hypothermia (List separately in addition to code for primary anesthesia procedure) units: 5 anesASABaseUnit: '05' anesCMSBaseUnit: '05' anesTimeUnit: '11.10' '400': description: Bad request content: application/json: schema: $ref: '#/components/schemas/Notification' example: error: - The code provided 'E11.01' in this web service request is not a valid 'cpt' code. warning: null info: null 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