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openapi: 3.2.0
info:
title: Optum DME and PEN Fee Schedule APIs API
version: v1.0
contact:
name: Ken Kracker
email: ken.kracker@optum.com
description: 'Operations tagged DME and PEN Fee Schedule 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: DME and PEN Fee Schedule APIs
paths:
/api/cms/common/fee-schedule/{fee-schedule-type}:
get:
tags:
- DME and PEN Fee Schedule APIs
summary: Fetches DME or PEN fee schedule for all states
operationId: getOutpatientFees
parameters:
- name: fee-schedule-type
in: path
required: true
schema:
type: string
enum:
- DME
- PEN
- name: sort
in: query
description: Any of these (code,-code,modifier,-modifier,modifier2,-modifier2,category,-category,state,-state,nonRuralFee,-nonRuralFee,ruralFee,-ruralFee) are allowed values.
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 DME/PEN fees for all states
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
content:
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: AZ
nonRuralFee: '0.58'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: CA
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: CO
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: CT
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: DC
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: DE
nonRuralFee: '0.59'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: FL
nonRuralFee: '0.55'
ruralFee: '0.00'
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: GA
nonRuralFee: '0.59'
ruralFee: '0.00'
totalCount: 2
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-08-14T16:46:24.623+00:00'
status: 400
error: Bad Request
path: /cmscommonms/api/cms/common/fee-schedule/test
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/DME
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
servers:
- url: /v1/cmscommonms
/api/cms/common/fee-schedule/{fee-schedule-type}/{state}:
get:
tags:
- DME and PEN Fee Schedule APIs
summary: Fetches DME OR PEN fee schedule for specific state
operationId: getOutpatientFees_1
parameters:
- name: fee-schedule-type
in: path
required: true
schema:
type: string
enum:
- DME
- PEN
- name: state
in: path
description: State
required: true
schema:
type: string
example: AL
- name: sort
in: query
description: Any of these (code,-code,modifier,-modifier,modifier2,-modifier2,category,-category,state,-state,nonRuralFee,-nonRuralFee,ruralFee,-ruralFee) are allowed values.
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 DME/PEN Fees for specific state
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
content:
- code: A4216
codeDescription: Sterile water, saline and/or dextrose, diluent/flush, 10 ml
category: OS
state: AL
nonRuralFee: '0.55'
ruralFee: '0.00'
- code: A4217
codeDescription: Sterile water/saline, 500 ml
modifier: AU
category: OS
state: AL
nonRuralFee: '3.54'
ruralFee: '0.00'
- code: A4217
codeDescription: Sterile water/saline, 500 ml
category: SU
state: AL
nonRuralFee: '3.54'
ruralFee: '0.00'
- code: A4221
codeDescription: Supplies for maintenance of noninsulin drug infusion catheter, per week (list drugs separately)
category: SU
state: AL
nonRuralFee: '25.41'
ruralFee: '26.97'
- code: A4222
codeDescription: Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately)
category: SU
state: AL
nonRuralFee: '49.45'
ruralFee: '53.68'
- code: A4224
codeDescription: Supplies for maintenance of insulin infusion catheter, per week
category: SU
state: AL
nonRuralFee: '25.41'
ruralFee: '26.97'
- code: A4225
codeDescription: Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
category: SU
state: AL
nonRuralFee: '3.28'
ruralFee: '3.36'
- code: A4233
codeDescription: Replacement battery, alkaline (other than J cell), for use with medically necessary home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '0.51'
ruralFee: '0.00'
- code: A4234
codeDescription: Replacement battery, alkaline, J cell, for use with medically necessary home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '2.36'
ruralFee: '0.00'
- code: A4235
codeDescription: Replacement battery, lithium, for use with medically necessary home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '1.00'
ruralFee: '0.00'
- code: A4236
codeDescription: Replacement battery, silver oxide, for use with medically necessary home blood glucose monitor owned by patient, each
modifier: NU
category: IN
state: AL
nonRuralFee: '1.16'
ruralFee: '0.00'
- code: A4238
codeDescription: Supply allowance for adjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
modifier: KF
category: SU
state: AL
nonRuralFee: '261.95'
ruralFee: '0.00'
- code: A4239
codeDescription: Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
modifier: KF
category: SU
state: AL
nonRuralFee: '296.72'
ruralFee: '0.00'
- code: A4239
codeDescription: Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of service
category: SU
state: AL
nonRuralFee: '255.01'
ruralFee: '0.00'
- code: A4253
codeDescription: Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
modifier: NU
category: IN
state: AL
nonRuralFee: '8.32'
ruralFee: '0.00'
- code: A4255
codeDescription: Platforms for home blood glucose monitor, 50 per box
category: SU
state: AL
nonRuralFee: '5.47'
ruralFee: '0.00'
- code: A4256
codeDescription: Normal, low, and high calibrator solution/chips
category: SU
state: AL
nonRuralFee: '3.38'
ruralFee: '0.00'
- code: A4257
codeDescription: Replacement lens shield cartridge for use with laser skin piercing device, each
category: SU
state: AL
nonRuralFee: '16.97'
ruralFee: '0.00'
totalCount: 3367
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- Invalid state value. Length should be 2
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/DME/AL
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
servers:
- url: /v1/cmscommonms
/api/cms/common/fee-schedule/zip-code/{state}:
get:
tags:
- DME and PEN Fee Schedule APIs
summary: Fetches rural ZIP codes available for given state
operationId: getZipCodes
parameters:
- name: state
in: path
description: State
required: true
schema:
type: string
example: AL
- 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 DME fees for all states
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
content:
- zipCode: '35010'
- zipCode: '35011'
- zipCode: '35014'
- zipCode: '35016'
- zipCode: '35019'
totalCount: 5
'400':
description: Bad request
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- 'getZipCodes.filter: length must be between 2 and 30'
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-07-13T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/fee-schedule/zip-codes/AL
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
servers:
- url: /v1/cmscommonms
components:
schemas:
Notification:
type: object
properties:
error:
type: array
items:
type: string
warning:
type: array
items:
type: string
info:
type: array
items:
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