openapi: 3.0.1
info:
title: CMS Common Facility
description: MicroService that contains CMS related information
contact:
name: Ken Kracker
email: ken.kracker@optum.com
version: v1.0
servers:
- url: /v1/cmscommonms
paths:
/api/cms/facility/supporting-documents/:
post:
tags:
- Supporting Documentation APIs
summary: Fetches lists of data for supporting documentation
operationId: getSupportingDocumentationDetails
parameters:
- name: sort
in: query
description: Any of these values (publicationType,-publicationType, postDate,-postDate,effectiveDate,-effectiveDate)
are allowed. The default is -postDate
required: false
schema:
type: array
items:
type: string
default:
- -postDate
- 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: yyyy-MM-dd
in: header
description: Date for which historical data is required
required: false
schema:
type: string
format: yyyy-MM-dd
requestBody:
description: Supporting documentation search request
content:
application/json:
schema:
$ref: '#/components/schemas/SupportingDocument'
examples:
Supporting Documentation Search Request:
description: Supporting Documentation Search Request
value:
publicationType: ''
fileName: ''
publicationSubject: ''
postDate: ''
effectiveDate: ''
required: true
responses:
'200':
description: Post-for-GET - Fetch list of supporting documentation
content:
application/json:
example:
content:
- docId: 2389
publicationType: MLN MATTERS
fileName: MM7134
heading: Fiscal Year (FY) 2011 Inpatient Prospective Payment System (IPPS), Long Term
Care Hospital (LTCH) PPS, and Inpatient Psychiatric Facility (IPF) PPS Changes
postDate: '2010-10-01 00:00:00'
effectiveDate: '2010-10-01 00:00:00'
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-05-18T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /api/cms/facility/supporting-documents
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-05-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/facility/supporting-documents/
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/transmittal/:
post:
tags:
- CMS Transmittal APIs
summary: Fetches the data for CMS Transmittal
operationId: getCMSTransmittal
parameters:
- name: sort
in: query
description: Any of these values(publicationType,-publicationType,publicationSubject,-publicationSubject,transmittalNumber,-transmittalNumber,changeRequest,-changeRequest,postDate,-postDate,effectiveDate,-effectiveDate,docImpDate,-docImpDate,rescinded,-rescinded,replacedBy,-replacedBy,relatedDocName,-relatedDocName,retroactiveFlag,-retroactiveFlag,healthCareTypes,-healthCareTypes,specialities,-specialities
) are allowed.The default is -effectiveDate
required: false
schema:
type: array
items:
type: string
default: []
- 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: 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/CMSTransmittal'
responses:
'200':
description: 'POST-for-GET: Fetch CMS Transmittal '
content:
application/json:
example:
content:
- docId: 615315
documentSourceId: 4
publicationType: Pub 100-04 Medicare Claims Processing
publicationSubject: Annual Updates to the Prior Authorization/Pre-Claim Review Federal
Holiday Schedule Tables for Generating Reports
transmittalNumber: R12026CP
changeRequest: '13151'
postDate: '2023-05-11 00:00:00'
effectiveDate: '2024-01-01 00:00:00'
docImpDate: '2023-10-02 00:00:00'
healthCareTypes: ALL TYPES
specialities: ALL PROVIDERS
'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/common/transmittalssss
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/transmittal
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/common/policy-lookup/:
post:
tags:
- Policy Lookup APIs
summary: Fetches all the policies of a given policy type and given code and/or term
operationId: searchPolicyLookup
parameters:
- name: sort
in: query
description: Any of these (contractorType,-contractorType,serviceAreas,-serviceAreas) are allowed
values, default is -contractorType
required: false
schema:
type: array
items:
type: string
default:
- contractorType
- 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: 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/PolicySearchRequest'
responses:
'200':
description: 'POST-for-GET - Search Policy Lookup '
content:
application/json:
example:
content:
- icpContractorId: 176
icpPolicyId: 535110
determinationNum: A59355
contractorType: MA
contractorName: CGS Administrators, LLC
policyType: LCD
cms: A59355
policyTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
effectiveDate: '2023-06-29'
url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59355&ver=6&bc=0
serviceAreas: KY
contractorNum: '15101'
hasArticles: '0'
displayName: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
scrubbedTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
contractorServiceAreas: 15101 - CGS Administrators, LLC (KY)
contractorTypeDisplayName: Part A - FI
- icpContractorId: 177
icpPolicyId: 535111
determinationNum: A59355
contractorType: MA
contractorName: CGS Administrators, LLC
policyType: LCD
cms: A59355
policyTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
effectiveDate: '2023-06-29'
url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59355&ver=6&bc=0
serviceAreas: OH
contractorNum: '15201'
hasArticles: '0'
displayName: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
scrubbedTitle: 'Response to Comments: Positron Emission Tomography (PET) for Inflammation
and Infection'
contractorServiceAreas: 15201 - CGS Administrators, LLC (OH)
contractorTypeDisplayName: Part A - FI
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/common/policy-lookuppp
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-07-28T06:36:22.518+00:00'
path: /cmscommonms/api/cms/common/policy-lookup
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/app/cms/common/policy-lookup/{policy-id}/related-articles:
get:
tags:
- Policy Lookup APIs
summary: Fetches LCD related articles of a given LCD policy id
operationId: fetchRelatedLCDPolicyByPolicyById
parameters:
- name: policy-id
in: path
description: Policy Id
required: true
schema:
type: string
example: 497873
- 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/PolicyValue'
security:
- bearerAuth: []
/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: []
/app/cms/common/cci/codeValidator:
get:
tags:
- CCI Edits Code Validator API
summary: Returns list of valid codes from a string of comma separated codes
operationId: fetchValidCodes
parameters:
- name: codes
in: query
description: Takes comma separated codes with minimum of 1 code 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: array
items:
type: string
security:
- bearerAuth: []
/api/cms/{mueType}/mue:
get:
tags:
- Medically Unlikely Edits(MUEs) APIs
summary: Fetches the Medically Unlikely Edits table data for MUE Physician OR Facility
operationId: getMueTableData
parameters:
- name: mueType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- 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 )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 MUE list
content:
application/json:
example:
content:
- code: 0001A
unit: '1'
mueAdjIndicator: '2 Date of Service Edit: Policy'
mueRationale: Code Descriptor / CPT Instruction
- code: 0001U
unit: '1'
mueAdjIndicator: '2 Date of Service Edit: Policy'
mueRationale: Code Descriptor / CPT Instruction
totalCount: 2
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2023-12-2T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/mue
security:
- bearerAuth: []
/api/cms/{iomType}/iom-policy/{codeType}/{code}:
get:
tags:
- CMS IOM's Policy APIs
summary: 'Fetches CMS IOM policies '
operationId: getCMSIOMSPolicies
parameters:
- name: codeType
in: path
required: true
schema:
type: string
enum:
- cpt
- hcpcs
- name: iomType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: code
in: path
required: true
schema:
type: string
example: 90740
- 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: 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 CMS IOM policies '
content:
application/json:
example:
content:
- policyId: '11546543'
policyName: 100-04,18,10.2.1
policyText: Healthcare Common Procedure Coding System (HCPCS) and Diagnosis Codes<br>Vaccines
and their administration are reported using separate codes. The following codes are
for reporting the vaccines only.
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2023-10-20T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/iom-policy/invalid
'500':
description: Interal server error
content:
application/json:
example:
timestamp: '2023-10-20T06:37:03.741+00:00'
path: /cmscommonms/api/cms/iom-policy
status: 500
error: Internal Server Error
requestId: e36d239e-324
security:
- bearerAuth: []
/api/cms/{cmsType}/policy-list/ncd/{contractorPart}/{codetype}/{code}:
get:
tags:
- Medicare Coverage Policy for part A and Part B APIs
summary: Fetches NCD Policies for particular Contractor part and Code (procedural or diagnosis)
operationId: getNCDPolicyList
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- hcpcs
- i9v3
- cpt
- i9v1
- i10_pcs
- i10_cm
- name: code
in: path
required: true
schema:
type: string
example: A4575
- name: cmsType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: contractorPart
in: path
required: true
schema:
type: string
enum:
- DME
- B
- A
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- 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 NCD policies for particular contractor part and code (procedural or diagnosis)
content:
application/json:
example:
content:
- icpContractorId: 0
icpPolicyId: 274765
determinationNum: 240.2.1
policyType: NCD
cms: 240.2.1
policyTitle: NCD for Home Use of Oxygen in Approved Clinical Trials (240.2.1)
effectiveDate: '2006-03-20'
url: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=312&ncdver=1&DocID=240.2.1&bc=gAAAAAgAAAAAAA%3d%3d&
hasArticles: '0'
displayName: 'Home Use of Oxygen in Approved Clinical Trials '
totalCount: 1
'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
'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/physician/policy-list/NCD/C/HCPCS/A4575
security:
- bearerAuth: []
/api/cms/{cmsType}/policy-list/lcd/{contractorPart}/{codetype}/{code}:
get:
tags:
- Medicare Coverage Policy for part A and Part B APIs
summary: Fetches LCD policies for particular contractor Id , contractor part and code (procedural
or diagnosis)
operationId: getLCDPolicyList
parameters:
- name: codetype
in: path
required: true
schema:
type: string
enum:
- hcpcs
- i9v3
- cpt
- i9v1
- i10_pcs
- i10_cm
- name: code
in: path
required: true
schema:
type: string
example: A4575
- name: cmsType
in: path
required: true
schema:
type: string
enum:
- physician
- facility
- name: contractorPart
in: path
required: true
schema:
type: string
enum:
- A
- B
- DME
- name: sort
in: query
description: Any of these (serviceAreas,-serviceAreas) are allowed values, default is serviceAreas
required: false
schema:
type: array
items:
type: string
default:
- serviceAreas
- name: limit
in: query
required: false
schema:
type: integer
format: int32
default: 50
example: 50
- name: page
in: query
required: false
schema:
type: integer
format: int32
default: 1
- name: contractor-id
in: query
required: false
schema:
type: integer
format: int32
example: 128
- 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 LCD policies for particular contractor id , contractor part and code (procedural
or diagnosis)
content:
application/json:
example:
content:
- icpContractorId: 128
icpPolicyId: 528715
determinationNum: L37873
contractorType: MA
contractorName: Palmetto GBA
policyType: LCD
cms: L37873
policyTitle: Topical Oxygen Therapy
effectiveDate: '2019-05-06'
url: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=37873&ver=14&bc=0
serviceAreas: SC
contractorNum: '11201'
hasArticles: '2'
totalCount: 1
'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/policy-list/LCD/C/HCPCS/A4575?contractor_id=128
security:
- bearerAuth: []
/api/cms/facility/{procedure-device-type}:
get:
tags:
- Device Codes APIs
summary: Fetches the device to procedure/procedure to device codes and their descriptions
operationId: getProcedureToDeviceToProcedureCodes
parameters:
- name: procedure-device-type
in: path
required: true
schema:
type: string
enum:
- device-to-procedure
- procedure-to-device
- name: sort
in: query
description: Any of these values (code,-code) are allowed.The 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: 'Fetches device to procedure/procedure to device codes list '
content:
application/json:
example:
content:
- code: C1721
codeDescription: Cardioverter-defibrillator, dual chamber (implantable)
- code: C1722
codeDescription: Cardioverter-defibrillator, single chamber (implantable)
totalCount: 2
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-05T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/device-to-procedure-invalid
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-05T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/facility/device-to-procedure
security:
- bearerAuth: []
/api/cms/facility/{procedure-device-type}/{device-or-procedure-code}:
get:
tags:
- Device Codes APIs
summary: Fetches device to procedure/procedure to device codes and their descriptions for a specific
device or procedure code
operationId: getProcedureToDeviceToProcedureCodeSpecific
parameters:
- name: procedure-device-type
in: path
required: true
schema:
type: string
enum:
- device-to-procedure
- procedure-to-device
- name: device-or-procedure-code
in: path
required: true
schema:
type: string
example: C1721
- name: sort
in: query
description: Any of these values (code,-code) are allowed.The 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: Fetches device to procedure/procedure to device codes list for a specific device
or procedure code
content:
application/json:
example:
content:
- code: '33224'
codeDescription: Insertion of pacing electrode, cardiac venous system, for left ventricular
pacing, with attachment to previously placed pacemaker or implantable defibrillator
pulse generator (including revision of pocket, removal, insertion, and/or replacement
of existing generator)
- code: '33230'
codeDescription: Insertion of implantable defibrillator pulse generator only; with existing
dual leads
totalCount: 2
'400':
description: 'Bad Request: Some parameters were invalid'
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
error:
- sort parameter value should be from list of [code]
warning: null
info: null
'404':
description: Not found
content:
application/json:
schema:
$ref: '#/components/schemas/Notification'
example:
timestamp: '2024-04-05T06:37:03.741+00:00'
status: 404
error: Not Found
message: Not Found
path: /cmscommonms/api/cms/facility/device-to-procedure-invalid/C1721
'500':
description: Internal server error
content:
application/json:
example:
timestamp: '2024-04-05T08:10:07.573+00:00'
status: 500
error: Internal Server Error
message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must
not be less than one'
path: /cmscommonms/api/cms/facility/device-to-procedure/C1721
security:
- bearerAuth: []
/api/cms/facility/{device-type}:
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# Full source: https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-cms-common-facility-openapi.yml