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OpenAPI Specification

openapi: 3.2.0
info:
  title: Backworkhealth Com Spending API
  version: 1.0.0
  contact:
    email: support@backworkhealth.com
    url: https://backworkhealth.com
  license:
    name: Proprietary
    url: https://backworkhealth.com/terms
  description: 'Operations tagged Spending across 2 of this provider''s published API definitions: backworkhealth-com-openapi.json, backworkhealth-com-v1-openapi.json. Each path carries the servers of the definition it was published in.'
servers:
- url: https://backworkhealth.com/api/v1
  description: Production server
- url: http://localhost:3000/api/v1
  description: Local development
security:
- bearerAuth: []
tags:
- name: Spending
  description: Medicare spending and utilization by billing code
paths:
  /spending/by-code:
    get:
      tags:
      - Spending
      summary: Get Medicaid spending by code
      description: Returns aggregate Medicaid provider spending statistics per HCPCS code, including totals and year-over-year breakdowns from CMS claims data. Provide `code` or `codes`. Requested codes with no data return zeroed totals. Patient counts are publisher row-level sums, not deduplicated people.
      operationId: getSpendingByCode
      parameters:
      - name: code
        in: query
        description: Single HCPCS code to look up
        required: false
        schema:
          examples:
          - T1019
          type: string
          minLength: 1
          maxLength: 10
      - name: codes
        in: query
        description: Comma-separated list of HCPCS codes (max 10)
        required: false
        schema:
          examples:
          - T1019,T1020
          type: string
          maxLength: 100
      - name: year
        in: query
        description: Filter the yearly breakdown to a specific year
        required: false
        schema:
          examples:
          - 2023
          type: integer
          minimum: 2000
          maximum: 2100
      responses:
        '200':
          description: Spending data keyed by HCPCS code
          content:
            application/json:
              schema:
                type: object
                properties:
                  success:
                    type: boolean
                    const: true
                  data:
                    type: object
                    propertyNames:
                      type: string
                    additionalProperties:
                      $ref: '#/components/schemas/CodeSpendingData'
                  meta:
                    type: object
                    properties:
                      request_id:
                        type: string
                        description: Unique request identifier for tracing
                      timestamp:
                        type: string
                        format: date-time
                        description: Response timestamp
                      codes_requested:
                        type: integer
                      patient_count_semantics:
                        type: string
                        const: sum_of_source_row_counts_not_distinct_people
                        description: Patient counts are summed at publisher row grain and are not deduplicated people
                      patient_count_disclosure:
                        type: string
                      year_filter:
                        type: integer
                    required:
                    - request_id
                    - timestamp
                    - codes_requested
                    - patient_count_semantics
                    - patient_count_disclosure
                required:
                - success
                - data
                - meta
        '400':
          description: 'Error: `VALIDATION_ERROR`'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ErrorResponse'
              example:
                success: false
                error:
                  code: VALIDATION_ERROR
                  message: Request validation failed
                  hint: Fix the fields listed in details, then send the corrected request
                  docUrl: https://backworkhealth.com/docs/errors#validation-error
                  retryable: false
                meta:
                  request_id: req_abc123
                  timestamp: '2024-01-15T10:30:00Z'
        '401':
          description: 'Error: `AUTH_MISSING`, `AUTH_INVALID_FORMAT`, `AUTH_INVALID_TOKEN`, `AUTH_KEY_NOT_FOUND`, `AUTH_KEY_REVOKED`, `AUTH_KEY_SUSPENDED`, `AUTH_TEST_KEY_SANDBOX_ONLY`'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ErrorResponse'
              example:
                success: false
                error:
                  code: AUTH_MISSING
                  message: Missing Authorization header
                  hint: 'Include "Authorization: Bearer bwk_xxx" header'
                  docUrl: https://backworkhealth.com/docs/errors#auth-missing
                  retryable: false
                meta:
                  request_id: req_abc123
                  timestamp: '2024-01-15T10:30:00Z'
        '402':
          description: 'Error: `BILLING_CREDITS_EXHAUSTED`, plan-gate denial'
          content:
            application/json:
              schema:
                oneOf:
                - $ref: '#/components/schemas/ErrorResponse'
                - $ref: '#/components/schemas/GateDenialResponse'
              example:
                success: false
                error:
                  code: BILLING_CREDITS_EXHAUSTED
                  message: Your organization has no request credits left for this call
                  hint: details.requests_required is this call's cost and details.requests_available is the balance. Retry once the balance covers the call. An organization admin can manage the plan and usage in the Backwork dashboard at https://backworkhealth.com/api-usage
                  docUrl: https://backworkhealth.com/docs/errors#billing-credits-exhausted
                  retryable: false
                meta:
                  request_id: req_abc123
                  timestamp: '2024-01-15T10:30:00Z'
        '403':
          description: 'Error: `AUTHZ_SCOPE_REQUIRED`, `AUTHZ_ORIGIN_NOT_ALLOWED`'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ErrorResponse'
              example:
                success: false
                error:
                  code: AUTHZ_SCOPE_REQUIRED
                  message: Insufficient permissions for this operation
                  hint: details.required_scopes lists the scopes this operation accepts
                  docUrl: https://backworkhealth.com/docs/errors#authz-scope-required
                  retryable: false
                meta:
                  request_id: req_abc123
                  timestamp: '2024-01-15T10:30:00Z'
        '429':
          description: 'Error: `RATE_LIMIT_EXCEEDED`'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ErrorResponse'
              example:
                success: false
                error:
                  code: RATE_LIMIT_EXCEEDED
                  message: Rate limit exceeded
                  hint: Wait the number of seconds in the Retry-After header, then retry
                  docUrl: https://backworkhealth.com/docs/errors#rate-limit-exceeded
                  retryable: true
                meta:
                  request_id: req_abc123
                  timestamp: '2024-01-15T10:30:00Z'
        '500':
          description: 'Error: `SERVER_INTERNAL_ERROR`'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ErrorResponse'
              example:
                success: false
                error:
                  code: SERVER_INTERNAL_ERROR
                  message: Internal server error
                  hint: Contact support@backworkhealth.com with the request_id from this response
                  docUrl: https://backworkhealth.com/docs/errors#server-internal-error
                  retryable: false
                meta:
                  request_id: req_abc123
                  timestamp: '2024-01-15T10:30:00Z'
    servers:
    - url: https://backworkhealth.com/api/v1
      description: Production server
    - url: http://localhost:3000/api/v1
      description: Local development
components:
  schemas:
    JsonArray:
      type: array
      items:
        $ref: '#/components/schemas/JsonValue'
    ErrorResponse:
      type: object
      properties:
        success:
          type: boolean
          const: false
        error:
          type: object
          properties:
            code:
              $ref: '#/components/schemas/ApiErrorCode'
            message:
              type: string
              description: Human-readable error message
            hint:
              description: Suggestion for resolving the error
              type: string
            docUrl:
              description: Link to error documentation
              type: string
              format: uri
            retryable:
              type: boolean
              description: Whether repeating the identical request later can succeed
            details:
              description: Additional error details
              $ref: '#/components/schemas/JsonValue'
          required:
          - code
          - message
          - retryable
        meta:
          $ref: '#/components/schemas/ResponseMeta'
      required:
      - success
      - error
      - meta
    CodeSpendingData:
      type: object
      properties:
        total_paid:
          type: string
          description: Total paid, as a decimal string
          examples:
          - '1234567.89'
        total_claims:
          type: integer
        reported_patient_count_sum:
          type: integer
        patient_count_semantics:
          type: string
          const: sum_of_source_row_counts_not_distinct_people
          description: Patient counts are summed at publisher row grain and are not deduplicated people
        unique_providers:
          type: integer
        date_range:
          type: object
          properties:
            min:
              type:
              - string
              - 'null'
            max:
              type:
              - string
              - 'null'
          required:
          - min
          - max
        by_year:
          type: array
          items:
            type: object
            properties:
              year:
                type: integer
              total_paid:
                type: string
              total_claims:
                type: integer
              reported_patient_count_sum:
                type: integer
            required:
            - year
            - total_paid
            - total_claims
            - reported_patient_count_sum
      required:
      - total_paid
      - total_claims
      - reported_patient_count_sum
      - patient_count_semantics
      - unique_providers
      - date_range
      - by_year
    ApiErrorCode:
      type: string
      enum:
      - AUTH_MISSING
      - AUTH_INVALID_FORMAT
      - AUTH_INVALID_KEY_FORMAT
      - AUTH_INVALID_TOKEN
      - AUTH_KEY_NOT_FOUND
      - AUTH_KEY_REVOKED
      - AUTH_KEY_SUSPENDED
      - AUTH_KEY_EXPIRED
      - AUTH_SANDBOX_TEST_KEY_REQUIRED
      - AUTH_TEST_KEY_SANDBOX_ONLY
      - AUTHZ_SCOPE_REQUIRED
      - AUTHZ_IP_NOT_ALLOWED
      - AUTHZ_ORIGIN_NOT_ALLOWED
      - BILLING_FEATURE_REQUIRED
      - BILLING_CREDITS_EXHAUSTED
      - RATE_LIMIT_EXCEEDED
      - RATE_QUOTA_EXCEEDED
      - RATE_CONCURRENT_EXCEEDED
      - VALIDATION_ERROR
      - VALIDATION_INVALID_JSON
      - VALIDATION_REQUIRED_FIELD
      - VALIDATION_OUT_OF_RANGE
      - VALIDATION_INVALID_FORMAT
      - PHI_NOT_ALLOWED
      - RESOURCE_NOT_FOUND
      - RESOURCE_POLICY_NOT_FOUND
      - RESOURCE_CODE_NOT_FOUND
      - RESOURCE_JURISDICTION_NOT_FOUND
      - RESOURCE_PAYER_NOT_FOUND
      - RESOURCE_RELEASE_NOT_AVAILABLE
      - REQUEST_INVALID_CURSOR
      - REQUEST_IDEMPOTENCY_CONFLICT
      - REQUEST_IDEMPOTENCY_IN_PROGRESS
      - REQUEST_UNSUPPORTED_CONTENT_TYPE
      - REQUEST_FORMAT_NOT_ACCEPTABLE
      - SERVER_INTERNAL_ERROR
      - SERVER_DATABASE_ERROR
      - SERVER_SEARCH_UNAVAILABLE
      - SERVER_TIMEOUT
      - SERVER_UNAVAILABLE
      - SERVER_IDEMPOTENCY_UNAVAILABLE
      - SERVER_UPSTREAM_UNAVAILABLE
      - COMMERCIAL_SURFACE_UNAVAILABLE
      description: Machine-readable error code
    ResponseMeta:
      type: object
      properties:
        request_id:
          type: string
          description: Unique request identifier for tracing
        timestamp:
          type: string
          format: date-time
          description: Response timestamp
      required:
      - request_id
      - timestamp
    GateDenialResponse:
      type: object
      properties:
        success:
          type: boolean
          const: false
        error:
          type: object
          properties:
            code:
              type: string
              enum:
              - INVALID_API_KEY
              - SUBSCRIPTION_INACTIVE
              - FEATURE_NOT_AVAILABLE
              - USAGE_LIMIT_EXCEEDED
              - DAILY_LIMIT_EXCEEDED
            message:
              type: string
              description: Which limit or feature check failed, when it resets, and who can manage the plan
          required:
          - code
          - message
        meta:
          $ref: '#/components/schemas/ResponseMeta'
      required:
      - success
      - error
      - meta
      description: The plan does not include this feature or its usage is exhausted.
    JsonObject:
      type: object
      propertyNames:
        type: string
      additionalProperties:
        $ref: '#/components/schemas/JsonValue'
    JsonValue:
      anyOf:
      - type: string
      - type: number
      - type: boolean
      - type: 'null'
      - $ref: '#/components/schemas/JsonArray'
      - $ref: '#/components/schemas/JsonObject'
      description: Any JSON value.
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: API Key
      description: 'API key in format: bwk_live_xxxxx. Keys issued before the rename (vrt_live_) remain valid. bwk_test_ keys work only on the sandbox.'
x-refined-from:
- backworkhealth-com-openapi.json
- backworkhealth-com-v1-openapi.json