CMS Blue Button 2.0 Explanation of Benefit API

openapi: 3.0.3
info:
  title: CMS Blue Button 2.0 API
  description: >-
    Blue Button 2.0 is the Centers for Medicare & Medicaid Services (CMS)
    patient-facing API that lets Medicare beneficiaries share their Parts A, B,
    and D claims data with applications they authorize. The v2 API is FHIR R4
    (4.0.1) and conforms to the CARIN Blue Button Implementation Guide (CARIN
    Consumer Directed Payer Data Exchange, CDPDE). It exposes three FHIR
    resource types - ExplanationOfBenefit (claims), Patient (demographics),
    and Coverage (Part A/B/D enrollment) - plus a capability statement and an
    OpenID Connect userinfo endpoint. Every request is scoped to the single
    beneficiary who authorized the application through the OAuth 2.0
    authorization-code flow (PKCE S256 required) on Medicare.gov. The sandbox
    at sandbox.bluebutton.cms.gov mirrors production with synthetic data for
    10,000 enrollees.
  version: '2.0'
  contact:
    name: CMS Blue Button 2.0
    url: https://bluebutton.cms.gov
  termsOfService: https://bluebutton.cms.gov/terms/
servers:
  - url: https://api.bluebutton.cms.gov/v2/fhir
    description: Production (approved applications only)
  - url: https://sandbox.bluebutton.cms.gov/v2/fhir
    description: Sandbox (synthetic Medicare enrollee data, self-serve)
security:
  - oauth2:
      - patient/ExplanationOfBenefit.read
      - patient/Patient.read
      - patient/Coverage.read
tags:
  - name: ExplanationOfBenefit
    description: Medicare Parts A, B, and D claims as CARIN Blue Button EOB profiles.
  - name: Patient
    description: Beneficiary demographic and administrative data.
  - name: Coverage
    description: Medicare coverage resources, one per coverage type.
  - name: Metadata
    description: FHIR capability statement.
  - name: UserInfo
    description: OpenID Connect userinfo for the authorizing beneficiary.
paths:
  /ExplanationOfBenefit:
    get:
      operationId: searchExplanationOfBenefit
      tags:
        - ExplanationOfBenefit
      summary: Search a beneficiary's Medicare claims
      description: >-
        Returns the authorized beneficiary's Medicare Parts A, B, and D claims
        as ExplanationOfBenefit resources inside a FHIR Bundle, conforming to
        the CARIN Blue Button profiles.
      parameters:
        - name: patient
          in: query
          description: The FHIR logical id of the beneficiary Patient resource.
          schema:
            type: string
        - name: type
          in: query
          description: >-
            Claim type filter - one or more of carrier, pde, dme, hha, hospice,
            inpatient, outpatient, snf.
          schema:
            type: string
        - name: service-date
          in: query
          description: Filter claims by service date range using gt/lt/ge/le prefixes.
          schema:
            type: string
        - $ref: '#/components/parameters/lastUpdated'
        - name: excludeSAMHSA
          in: query
          description: >-
            When true, excludes claims related to substance abuse and mental
            health services (SAMHSA).
          schema:
            type: string
            enum: ['true', 'false']
        - name: includeTaxNumbers
          in: query
          description: When true, includes provider tax numbers in the response.
          schema:
            type: string
            enum: ['true', 'false']
        - $ref: '#/components/parameters/count'
        - $ref: '#/components/parameters/startIndex'
      responses:
        '200':
          description: A FHIR Bundle of ExplanationOfBenefit resources.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
        '401':
          $ref: '#/components/responses/Unauthorized'
  /ExplanationOfBenefit/{id}:
    get:
      operationId: readExplanationOfBenefit
      tags:
        - ExplanationOfBenefit
      summary: Read a single claim by id
      description: Returns a single ExplanationOfBenefit resource by FHIR logical id.
      parameters:
        - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          description: An ExplanationOfBenefit resource.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/ExplanationOfBenefit'
        '401':
          $ref: '#/components/responses/Unauthorized'
        '404':
          $ref: '#/components/responses/NotFound'
  /Patient:
    get:
      operationId: searchPatient
      tags:
        - Patient
      summary: Search the authorized beneficiary's Patient resource
      description: >-
        Returns the beneficiary's demographic and administrative record as a
        Patient resource in a FHIR Bundle. Available only if the beneficiary
        chose to share demographic data during authorization.
      parameters:
        - name: _id
          in: query
          description: The FHIR logical id of the Patient resource.
          schema:
            type: string
        - name: identifier
          in: query
          description: >-
            Search by business identifier (Medicare Beneficiary Identifier hash
            system identifiers).
          schema:
            type: string
        - $ref: '#/components/parameters/lastUpdated'
        - $ref: '#/components/parameters/count'
        - $ref: '#/components/parameters/startIndex'
      responses:
        '200':
          description: A FHIR Bundle containing the Patient resource.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
        '401':
          $ref: '#/components/responses/Unauthorized'
  /Patient/{id}:
    get:
      operationId: readPatient
      tags:
        - Patient
      summary: Read the beneficiary's Patient resource by id
      description: Returns the Patient resource for the authorizing beneficiary.
      parameters:
        - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          description: A Patient resource.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Patient'
        '401':
          $ref: '#/components/responses/Unauthorized'
        '404':
          $ref: '#/components/responses/NotFound'
  /Coverage:
    get:
      operationId: searchCoverage
      tags:
        - Coverage
      summary: Search a beneficiary's Medicare coverage
      description: >-
        Returns Coverage resources inside a FHIR Bundle - one Coverage resource
        per coverage type (Medicare Part A, Part B, Part D).
      parameters:
        - name: beneficiary
          in: query
          description: The FHIR logical id of the beneficiary Patient resource.
          schema:
            type: string
        - name: _profile
          in: query
          description: Filter the response to a specific CARIN Coverage profile.
          schema:
            type: string
        - $ref: '#/components/parameters/lastUpdated'
        - $ref: '#/components/parameters/count'
        - $ref: '#/components/parameters/startIndex'
      responses:
        '200':
          description: A FHIR Bundle of Coverage resources.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
        '401':
          $ref: '#/components/responses/Unauthorized'
  /Coverage/{id}:
    get:
      operationId: readCoverage
      tags:
        - Coverage
      summary: Read a single Coverage resource by id
      description: Returns a single Coverage resource by FHIR logical id.
      parameters:
        - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          description: A Coverage resource.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Coverage'
        '401':
          $ref: '#/components/responses/Unauthorized'
        '404':
          $ref: '#/components/responses/NotFound'
  /metadata:
    get:
      operationId: getCapabilityStatement
      tags:
        - Metadata
      summary: Retrieve the FHIR capability statement
      description: >-
        Returns the server CapabilityStatement (FHIR 4.0.1) describing the
        supported resources, interactions, and search parameters. Does not
        require authorization.
      security: []
      responses:
        '200':
          description: A CapabilityStatement resource.
          content:
            application/fhir+json:
              schema:
                type: object
                description: FHIR CapabilityStatement resource.
  /connect/userinfo:
    servers:
      - url: https://api.bluebutton.cms.gov/v2
        description: Production (userinfo lives outside the /fhir base path)
      - url: https://sandbox.bluebutton.cms.gov/v2
        description: Sandbox
    get:
      operationId: getUserInfo
      tags:
        - UserInfo
      summary: Retrieve the authorizing user's OpenID Connect profile
      description: >-
        Full path is /v2/connect/userinfo (outside the /fhir base). Returns the
        authorizing beneficiary's user profile (name, family name, email) when
        the openid and profile scopes were granted.
      responses:
        '200':
          description: OpenID Connect userinfo JSON.
          content:
            application/json:
              schema:
                type: object
                properties:
                  sub:
                    type: string
                  name:
                    type: string
                  given_name:
                    type: string
                  family_name:
                    type: string
                  email:
                    type: string
        '401':
          $ref: '#/components/responses/Unauthorized'
components:
  parameters:
    resourceId:
      name: id
      in: path
      required: true
      description: The FHIR logical id of the resource.
      schema:
        type: string
    lastUpdated:
      name: _lastUpdated
      in: query
      description: >-
        Filter by the record's last_updated date using gt/lt prefixes; may be
        supplied more than once to define a range.
      schema:
        type: string
    count:
      name: _count
      in: query
      description: Number of records per page for pagination.
      schema:
        type: integer
    startIndex:
      name: startIndex
      in: query
      description: Zero-based index of the first record to return for pagination.
      schema:
        type: integer
  responses:
    Unauthorized:
      description: Missing, expired, or invalid OAuth 2.0 access token.
    NotFound:
      description: No resource exists with the supplied id for this beneficiary.
  schemas:
    Bundle:
      type: object
      description: A FHIR R4 searchset Bundle wrapping matching resources.
      properties:
        resourceType:
          type: string
          enum: [Bundle]
        type:
          type: string
        total:
          type: integer
        link:
          type: array
          items:
            type: object
            properties:
              relation:
                type: string
              url:
                type: string
        entry:
          type: array
          items:
            type: object
            properties:
              resource:
                type: object
    ExplanationOfBenefit:
      type: object
      description: >-
        FHIR R4 ExplanationOfBenefit conforming to the CARIN Blue Button
        profiles - one of carrier, pde (Part D drug event), dme, hha, hospice,
        inpatient, outpatient, or snf claim types.
      properties:
        resourceType:
          type: string
          enum: [ExplanationOfBenefit]
        id:
          type: string
        type:
          type: object
        patient:
          type: object
        billablePeriod:
          type: object
        insurance:
          type: array
          items:
            type: object
        item:
          type: array
          items:
            type: object
        total:
          type: array
          items:
            type: object
    Patient:
      type: object
      description: FHIR R4 Patient resource for the authorizing Medicare beneficiary.
      properties:
        resourceType:
          type: string
          enum: [Patient]
        id:
          type: string
        identifier:
          type: array
          items:
            type: object
        name:
          type: array
          items:
            type: object
        birthDate:
          type: string
        address:
          type: array
          items:
            type: object
    Coverage:
      type: object
      description: >-
        FHIR R4 Coverage resource - one per Medicare coverage type (Part A,
        Part B, Part D).
      properties:
        resourceType:
          type: string
          enum: [Coverage]
        id:
          type: string
        status:
          type: string
        beneficiary:
          type: object
        class:
          type: array
          items:
            type: object
  securitySchemes:
    oauth2:
      type: oauth2
      description: >-
        OAuth 2.0 authorization-code flow with mandatory PKCE (S256 only).
        Beneficiaries log in with their Medicare.gov credentials and choose
        whether to share demographic data. Access tokens expire after 1 hour.
        One-time-use refresh tokens are issued only to approved 13-month and
        research application types. Sandbox uses
        https://sandbox.bluebutton.cms.gov/v2/o/authorize/ and
        https://sandbox.bluebutton.cms.gov/v2/o/token/.
      flows:
        authorizationCode:
          authorizationUrl: https://api.bluebutton.cms.gov/v2/o/authorize/
          tokenUrl: https://api.bluebutton.cms.gov/v2/o/token/
          refreshUrl: https://api.bluebutton.cms.gov/v2/o/token/
          scopes:
            patient/Patient.read: Read the beneficiary's Patient demographic resource.
            patient/ExplanationOfBenefit.read: Read the beneficiary's Medicare claims.
            patient/Coverage.read: Read the beneficiary's Medicare coverage.
            openid: OpenID Connect authentication.
            profile: Access the userinfo profile endpoint.
            launch/patient: Receive the patient FHIR id in the token response.