Optum

Optum CCI Edits APIs API

The CCI Edits APIs API from Optum — 10 operation(s) for cci edits apis.

Documentation GitHub OpenAPI

Business capability

Medical Coding Management BC-2870.20

Operations 10

GET /app/cms/common/cci/modifiers/{code} Fetches modifiers based on given code #

GET /api/cms/facility/cci/{code}/{column-type} Facility - Fetch CCI Edits for single code #

GET /api/cms/facility/cci/print Facility - Prints CCI Edits for multi code #

GET /api/cms/facility/cci/effective-date-version Facility - Fetch CCI Edits Effective Date and Version Description #

GET /api/cms/facility/cci/conflict-view Facility - fetch CCI edits for multi code conflict view #

GET /api/cms/facility/cci/cci-edits-list/{list-type} Facility - fetch CCI edits list for all, addition and deleted codes #

GET /api/cms/physician/cci/{market-type}/print Physician - Prints CCI Edits for multi code #

GET /api/cms/physician/cci/{market-type}/conflict-view Physician - Fecth CCI edits for multi code conflict view #

GET /api/cms/physician/cci/{market-type}/code-view Physician - Fecth CCI Edits for multi code Code View #

GET /api/cms/physician/cci/{code}/{column-type} Physician - Fetch CCI Edits for single code #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum CCI Edits APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged CCI Edits APIs across 2 of this provider''s published API definitions: optum-cms-common-facility-openapi.yml, optum-cms-common-physician-openapi.yml. Each path carries the servers of the definition it was published in.'
servers:
- url: /v1/cmscommonms
tags:
- name: CCI Edits APIs
paths:
  /app/cms/common/cci/modifiers/{code}:
    get:
      tags:
      - CCI Edits APIs
      summary: Fetches modifiers based on given code
      operationId: fetchRelatedLCDPolicyByPolicyById_1
      parameters:
      - name: code
        in: path
        description: Code
        required: true
        schema:
          type: string
        example: 99213
      - 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: OK
          content:
            '*/*':
              schema:
                $ref: '#/components/schemas/OptumPageImplModifiersPopUpValue'
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/facility/cci/{code}/{column-type}:
    get:
      tags:
      - CCI Edits APIs
      summary: Facility - Fetch CCI Edits for single code
      operationId: getSingleCodeView_1
      parameters:
      - name: code
        in: path
        required: true
        schema:
          type: string
        example: 99213
      - name: column-type
        in: path
        required: true
        schema:
          type: string
          enum:
          - primary
          - secondary
      - name: sort
        in: query
        description: Any of these (code,-code) are allowed values, 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: Facility - Fetch CCI Edits for single code
          content:
            application/json:
              example:
                content:
                - code: 0362T
                  description: Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient
                  modifier: modifier allowed, codes may be used together if documentation supports their use
                - code: 0373T
                  description: Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient
                  modifier: modifier allowed, codes may be used together if documentation supports their use
                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: /cmscommonms/api/cms/facility/cci/invalid
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/cci
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/facility/cci/print:
    get:
      tags:
      - CCI Edits APIs
      summary: Facility - Prints CCI Edits for multi code
      operationId: printCCIResults_1
      parameters:
      - name: codes
        in: query
        description: Takes comma separated codes with minimum of 2 codes and maximum of 36 codes
        required: true
        schema:
          type: string
        example: 99213,99214
      - 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
                format: byte
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/facility/cci/effective-date-version:
    get:
      tags:
      - CCI Edits APIs
      summary: Facility - Fetch CCI Edits Effective Date and Version Description
      operationId: getCCIEffectiveDateAndVersionDesc
      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: Facility - Fetch CCI Edits Effective Date and Version Description
          content:
            application/json:
              example:
                versionDesc: 94
                effDate: '2024-01-01 00:00:00'
        '404':
          description: Not found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Notification'
              example:
                timestamp: '2024-03-06T06:37:03.741+00:00'
                status: 404
                error: Not Found
                message: Not Found
                path: /cmscommonms/api/cms/facility/cci/invalid
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/facility/cci/conflict-view:
    get:
      tags:
      - CCI Edits APIs
      summary: Facility - fetch CCI edits for multi code conflict view
      operationId: getMultiCodeCodeView_1
      parameters:
      - name: codes
        in: query
        description: Takes comma separated codes with minimum of 2 codes and maximum of 50 codes
        required: true
        schema:
          type: string
        example: 99213,99214
      - 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: Facility - Fetch CCI Edits for CodeView or Conflict View
          content:
            application/json:
              example:
              - - code: '99214'
                  description: Office or other outpatient visit for the evaluation and management of an established patient
                  modifier: modifier allowed, codes may be used together if documentation supports their use
                - code: '99213'
                  description: Office or other outpatient visit for the evaluation and management of an established patient
                  modifier: modifier allowed, codes may be used together if documentation supports their use
        '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/cms/facility/cci/invalid
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/cci
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/facility/cci/cci-edits-list/{list-type}:
    get:
      tags:
      - CCI Edits APIs
      summary: Facility - fetch CCI edits list for all, addition and deleted codes
      operationId: getCCIEditsList
      parameters:
      - name: list-type
        in: path
        required: true
        schema:
          type: string
          enum:
          - all
          - addition
          - deletion
      - name: sort
        in: query
        description: Any of these (code1,-code1,code2,-code2,modifier,-modifier) are allowed values, default is -code1
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - code1
      - 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: Facility - Fetch CCI Edits List for all, addition and deleted codes
          content:
            application/json:
              example:
              - - code1: 0001U
                  code2: 0029U
                  modifier: 1
                  versionDesc: 94
                  effDate: '2024-01-01 00:00:00'
                - code1: 0001U
                  code2: 0030U
                  modifier: 1
                  versionDesc: 94
                  effDate: '2024-01-01 00:00:00'
        '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/cms/facility/cci/invalid
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/facility/cci
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/physician/cci/{market-type}/print:
    get:
      tags:
      - CCI Edits APIs
      summary: Physician - Prints CCI Edits for multi code
      operationId: printCCIResults
      parameters:
      - name: market-type
        in: path
        required: true
        schema:
          type: string
          enum:
          - non-facility
          - facility
      - name: codes
        in: query
        description: Takes comma separated codes with minimum of 2 codes and maximum of 36 codes
        required: true
        schema:
          type: string
        example: 99213,99214
      - name: viewType
        in: query
        description: Any of these view types (Conflict or Code) are allowed Types, default is Conflict Type
        required: false
        schema:
          type: string
          enum:
          - Conflict
          - Code
        example: Conflict
      - name: isMpfs
        in: query
        required: false
        schema:
          type: boolean
          default: true
        example: true
      - 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
                format: byte
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/physician/cci/{market-type}/conflict-view:
    get:
      tags:
      - CCI Edits APIs
      summary: Physician - Fecth CCI edits for multi code conflict view
      operationId: getMultiCodeConflictView
      parameters:
      - name: market-type
        in: path
        required: true
        schema:
          type: string
          enum:
          - non-facility
          - facility
      - name: codes
        in: query
        description: Takes comma separated codes with minimum of 2 codes and maximum of 50 codes
        required: true
        schema:
          type: string
        example: 99213,99214
      - 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 CCI edits for codeView or conflict view
          content:
            application/json:
              example:
              - - code: '99214'
                  description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encount
                  reason: Misuse of column two code with column one code
                  modifier: Allowed
                  workRVU: 1.92
                  nfPERVU: 1.79
                  nfTotalRVU: 3.85
                  malpracticeRVU: 0.14
                  nfTotalFee: 126.07
                  feeType: Non Facility
                  priSecText: Primary
                - code: '99213'
                  description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter fo
                  reason: Misuse of column two code with column one code
                  modifier: Allowed
                  workRVU: 1.3
                  nfPERVU: 1.33
                  nfTotalRVU: 2.73
                  malpracticeRVU: 0.1
                  nfTotalFee: 89.39
                  feeType: Non Facility
                  priSecText: Secondary
        '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/cms/cciii
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/cci
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/physician/cci/{market-type}/code-view:
    get:
      tags:
      - CCI Edits APIs
      summary: Physician - Fecth CCI Edits for multi code Code View
      operationId: getMultiCodeCodeView
      parameters:
      - name: market-type
        in: path
        required: true
        schema:
          type: string
          enum:
          - non-facility
          - facility
      - name: codes
        in: query
        description: Takes comma separated codes with minimum of 2 codes and maximum of 36 codes
        required: true
        schema:
          type: string
        example: 99213,99214
      - 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: Fecth CCI Edits for CodeView
          content:
            application/json:
              example:
              - code: '99213'
                cciEditsList:
                - - code: '13152'
                    description: Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm
                    reason: CPT Manual or CMS manual coding instructions
                    modifier: '1'
                    workRVU: 5.34
                    faPERVU: 3.95
                    faTotalRVU: 9.94
                    malpracticeRVU: 0.65
                    faTotalFee: 336.84
                    feeType: Facility
                    priSecText: Primary
                  - code: '99213'
                    description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of
                    reason: CPT Manual or CMS manual coding instructions
                    modifier: '1'
                    workRVU: 1.3
                    faPERVU: 0.55
                    faTotalRVU: 1.95
                    malpracticeRVU: 0.1
                    faTotalFee: 66.08
                    feeType: Facility
                    priSecText: Secondary
                - - code: '99215'
                    description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of
                    reason: Misuse of column two code with column one code
                    modifier: '1'
                    workRVU: 2.8
                    faPERVU: 1.23
                    faTotalRVU: 4.23
                    malpracticeRVU: 0.2
                    faTotalFee: 143.34
                    feeType: Facility
                    priSecText: Primary
                  - code: '99213'
                    description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of
                    reason: Misuse of column two code with column one code
                    modifier: '1'
                    workRVU: 1.3
                    faPERVU: 0.55
                    faTotalRVU: 1.95
                    malpracticeRVU: 0.1
                    faTotalFee: 66.08
                    feeType: Facility
                    priSecText: Secondary
        '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/cms/cciii
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/cci
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/physician/cci/{code}/{column-type}:
    get:
      tags:
      - CCI Edits APIs
      summary: Physician - Fetch CCI Edits for single code
      operationId: getSingleCodeView
      parameters:
      - name: code
        in: path
        required: true
        schema:
          type: string
        example: 99213
      - name: column-type
        in: path
        required: true
        schema:
          type: string
          enum:
          - primary
          - secondary
      - name: sort
        in: query
        description: Any of these (code,-code,reason,-reason,modifier,-modifier) are allowed values, 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: Fetch CCI edits for single code
          content:
            application/json:
              example:
                content:
                - code: '20560'
                  description: Needle insertion(s) without injection(s); 1 or 2 muscle(s)
                  reason: CPT Manual or CMS manual coding instructions
                  modifier: Allowed
                  workRVU: 0.32
                  nfPERVU: 0.44
                  faPERVU: 0.11
                  nfTotalRVU: 0.77
                  faTotalRVU: 0.44
                  malpracticeRVU: 0.01
                  nfTotalFee: 26.093144
                  faTotalFee: 14.910368
                - code: '20561'
                  description: Needle insertion(s) without injection(s); 3 or more muscles
                  reason: CPT Manual or CMS manual coding instructions
                  modifier: Allowed
                  workRVU: 0.48
                  nfPERVU: 0.62
                  faPERVU: 0.16
                  nfTotalRVU: 1.12
                  faTotalRVU: 0.66
                  malpracticeRVU: 0.02
                  nfTotalFee: 37.953664
                  faTotalFee: 22.365552
                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: /cmscommonms/api/cms/cciii
        '500':
          description: Interal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-28T06:36:22.518+00:00'
                path: /cmscommonms/api/cms/cci
                status: 500
                error: Internal Server Error
                requestId: e36d239e-324
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
components:
  schemas:
    OptumPageImplModifiersPopUpValue:
      type: object
      properties:
        content:
          type: array
          items:
            $ref: '#/components/schemas/ModifiersPopUpValue'
        totalCount:
          type: integer
          format: int64
    Notification:
      type: object
      properties:
        error:
          type: array
          items:
            type: string
        warning:
          type: array
          items:
            type: string
        info:
          type: array
          items:
            type: string
    ModifiersPopUpValue:
      type: object
      properties:
        modifier:
          type: string
        description:
          type: string
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-refined-from:
- optum-cms-common-facility-openapi.yml
- optum-cms-common-physician-openapi.yml
x-readme:
  explorer-enabled: true
  proxy-enabled: true