Optum

Optum LCD API

The LCD API from Optum — 4 operation(s) for lcd.

Documentation GitHub OpenAPI

Operations 4

GET /contractors List of medicare contractors who have policies #

GET /contractors/{contractorNum}/policies Policies of a Medicare Contractor #

GET /contractors/{contractorNum}/policy/{cmspolicyid} Medicare Policiy Details #

GET /contractors/regions Medicare contractor region list #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum Real-Time eContent Web services LCD API
  description: Optum® Real-Time eContent web services provides access to both ondemand medical coding data and Optum coding tool logic required by your applications. The information you or your clients need is delivered to your application in real time, when you need it, and customized to how you want it displayed. Optum Real-Time eContent service provides access to the content of 37 printed coding resources and proprietary data and offers the power of the Optum CodeLogic™ search engine.
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  version: 1.0.0
servers:
- url: sandbox-apigw.optum.com/ci/rtec/v1/ws
security:
- bearerAuth: []
tags:
- name: LCD
paths:
  /contractors:
    get:
      tags:
      - LCD
      summary: List of medicare contractors who have policies
      operationId: getContractors
      parameters:
      - name: contractor-type
        in: query
        description: 'Comma seperated list of <UL><LI>ALL : All of the following types of contractors</LI><LI>CA  : Carriers</LI><LI>DA  : DME MAC</LI><LI>DP  : DME PSC</LI><LI>FI  : Fiscal Intermediary</LI><LI>MA  : MAC Part A</LI><LI>MB  : MAC Part B</LI><LI>NA  : National Part A</LI><LI>NB  : National Part B</LI><LI>ND  : National DME</LI></UL>'
        schema:
          type: string
          default: CA,FI,MA,MB
      - name: contractor-part
        in: query
        description: 'Comma seperated list of <UL><LI>ALL : Contractors for all of the parts below</LI><LI>A : Contractor for Part A policies</LI><LI>B : Contractor for Part B policies</LI><LI>DME : Contractor for DME policies</LI></UL>'
        schema:
          type: string
          default: A,B
      - name: region-code
        in: query
        description: The region code for policies
        schema:
          type: string
          default: ALL
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorList'
              example:
                contractor:
                - regionCode: AK
                  regionName: Alaska
                  contractorName: BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator)
                  contractorPart: A
                  contractorType: FI
                  contractorNumber: 00390
                - regionCode: AK
                  regionName: Alaska
                  contractorName: Noridian Administrative Services
                  contractorPart: A
                  contractorType: FI
                  contractorNumber: '00322'
        '400':
          description: Not a valid 'codetype' code
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorList'
              example:
                error:
                - Invalid value 'X' for parameter 'contractor-part'.  Valid values are a comma seperated list of ALL,A,B,DME,HM,MP,NR,PI,RI
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Not Found - the data was not found
          content:
            application/json:
              example:
                error:
                - The requested resource does not exist.
                warning: []
                info: []
        '405':
          description: Method Not Allowed - Request method not supported
          content:
            application/json:
              example:
                timestamp: '2022-07-07T15:28:34.152Z'
                status: 405
                error: Method Not Allowed
        '503':
          description: Service Unavailable
  /contractors/{contractorNum}/policies:
    get:
      tags:
      - LCD
      summary: Policies of a Medicare Contractor
      operationId: getPolicies
      parameters:
      - name: contractorNum
        in: path
        description: The Contractor number (max 5 chars)
        required: true
        schema:
          type: string
        example: '04111'
      - name: cms-id
        in: query
        description: The CMS Policy ID (Max 10 characters)
        schema:
          type: string
      - name: contractor-part
        in: query
        description: 'Comma seperated list of <UL><LI>ALL : Contractors for all of the parts below</LI><LI>A : Contractor for Part A policies</LI><LI>B : Contractor for Part B policies</LI><LI>DME : Contractor for DME policies</LI></UL>'
        schema:
          type: string
          default: ALL
        example: ALL
      - name: contractor-type
        in: query
        description: 'Comma seperated list of <UL><LI>ALL : All of the following types of contractors</LI><LI>CA  : Carriers</LI><LI>DA  : DME MAC</LI><LI>DP  : DME PSC</LI><LI>FI  : Fiscal Intermediary</LI><LI>MA  : MAC Part A</LI><LI>MB  : MAC Part B</LI><LI>NA  : National Part A</LI><LI>NB  : National Part B</LI><LI>ND  : National DME</LI></UL>'
        schema:
          type: string
          default: ALL
        example: ALL
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorPolicies'
              example:
                policy:
                - title: 'Billing and Coding: Acute Care: Inpatient, Observation and Treatment Room Services'
                  effectiveDate: '2015-10-01T00:00:00.000Z'
                  url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=52985&ver=44&bc=0
                  cmsId: A52985
                  contractorNum: '04111'
                  contractorPart: A
                  contractorType: MA
                - title: 'Billing and Coding: Information Regarding Uses, Including Off-Label Uses, of Anti-Vascular Endothelial Growth Factor (anti-VEGF), for The Treatment of Ophthalmological Diseases'
                  effectiveDate: '2016-07-11T00:00:00.000Z'
                  url: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=53121&ver=35&bc=0
                  cmsId: A53121
                  contractorNum: '04111'
                  contractorPart: A
                  contractorType: MA
        '400':
          description: ContractorNum is larger than 5 characters
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorPolicies'
              example:
                error:
                - ContractorNum is larger than 5 characters
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Not Found - the data was not found
          content:
            application/json:
              example:
                error:
                - The requested resource does not exist.
                warning: []
                info: []
        '405':
          description: Method Not Allowed - Request method not supported
          content:
            application/json:
              example:
                timestamp: '2022-07-07T15:28:34.152Z'
                status: 405
                error: Method Not Allowed
        '503':
          description: Service Unavailable
  /contractors/{contractorNum}/policy/{cmspolicyid}:
    get:
      tags:
      - LCD
      summary: Medicare Policiy Details
      operationId: getPolicyDetails
      parameters:
      - name: contractorNum
        in: path
        description: The Contractor number (max 5 chars)
        required: true
        schema:
          type: string
        example: '04111'
      - name: cmspolicyid
        in: path
        description: The CMS Policy ID (Max 10 characters)
        required: true
        schema:
          type: string
        example: A52985
      - name: categories
        in: query
        description: 'Comma seperated list of <UL><LI>all  : All Categories below</LI><LI>tob  : Type of Bill Codes for lcd policies</LI><LI>rev  : Revenue Codes for lcd policies</LI><LI>proc : Procedure codes for ncd/lcd policies</LI><LI>diag : All Diagnostic codes for ncd/lcd policies</LI><LI>supp : Supported Diagnostic codes for lcd policies</LI><LI>cov  : Covered Diagnostic Codes for ncd policies</LI><LI>deny : Denied Diagnostic Codes for ncd policies</LI><LI>nots : Not Supported Diagnostic codes for ncd/lcd policies</LI></UL>'
        schema:
          type: string
          default: all
        example: all
      - name: icdtypes
        in: query
        description: 'Comma seperated list of <UL><LI>all   : all icd types below</LI><LI>icd9  : exclude icd10cm and icd10pcs</LI><LI>icd10 : exclude icd9v1 and icd9v3</LI></UL>'
        schema:
          type: string
          default: all
        example: all
      - name: maxproc
        in: query
        description: The maximum number of procedure codes to be returned
        schema:
          type: integer
          format: int32
          default: 200
      - name: maxcov
        in: query
        description: The maximum number of diagnostic codes to be returned under 'covered' for ncd policies
        schema:
          type: integer
          format: int32
          default: 200
      - name: maxnots
        in: query
        description: The maximum number of diagnostic codes to be returned under 'not-supporting-medical-necessity' for ncd/lcd policies
        schema:
          type: integer
          format: int32
          default: 200
      - name: maxdeny
        in: query
        description: The maximum number of diagnostic codes to be returned under 'denied'
        schema:
          type: integer
          format: int32
          default: 200
      - name: maxtob
        in: query
        description: The maximum number of codes to be returned under 'type-of-bill-codes' for lcd policies
        schema:
          type: integer
          format: int32
          default: 200
      - name: maxrev
        in: query
        description: The maximum number of codes to be returned under 'revenue-codes for lcd policies'
        schema:
          type: integer
          format: int32
          default: 200
      - name: maxsupp
        in: query
        description: The maximum number of diagnostic codes to be returned under 'supporting-medical-necessity' for lcd policies
        schema:
          type: integer
          format: int32
          default: 200
      - name: contractor-part
        in: query
        description: 'Comma seperated list of <UL><LI>ALL : Contractors for all of the parts below</LI><LI>A : Contractor for Part A policies</LI><LI>B : Contractor for Part B policies</LI><LI>DME : Contractor for DME policies</LI></UL>'
        schema:
          type: string
          default: ALL
        example: ALL
      - name: contractor-type
        in: query
        description: 'Comma seperated list of <UL><LI>ALL : All of the following types of contractors</LI><LI>CA  : Carriers</LI><LI>DA  : DME MAC</LI><LI>DP  : DME PSC</LI><LI>FI  : Fiscal Intermediary</LI><LI>MA  : MAC Part A</LI><LI>MB  : MAC Part B</LI><LI>NA  : National Part A</LI><LI>NB  : National Part B</LI><LI>ND  : National DME</LI></UL>'
        schema:
          type: string
          default: ALL
        example: ALL
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorPolicyDetails'
              example:
                policyInfo:
                  title: NCD for Injection Sclerotherapy for Esophageal Variceal Bleeding (100.10)
                  effectiveDate: '1984-10-29T00:00:00.000Z'
                  url: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?ncdid=95&ver=1
                  contractorNum: '0'
                  cmsId: '100.10'
                  contractorPart: A
                  contractorType: NA
                  icpPolicyId: 258971
                  policyType: NCD
                ncdCodingInformation:
                  procedureCodes:
                    codeInfo:
                    - code: '43204'
                      description: Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices
                      type: cpt
                    - code: '43243'
                      description: Esophagogastroduodenoscopy, flexible, transoral; with injection sclerosis of esophageal/gastric varices
                      type: cpt
                    numcodes: 2
                    toomanycodes: false
                  diagnosticCodes:
                    covered:
                      codeInfo: []
                    denied:
                      codeInfo: []
                    notSupportingMedicalNecessity:
                      codeInfo: []
        '400':
          description: ContractorNum is larger than 5 characters
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorPolicyDetails'
              example:
                error:
                - ContractorNum is larger than 5 characters
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Policy 'A9999' does not exist for Contractor '%04111'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ContractorPolicyDetails'
              example:
                error:
                - Policy 'A9999' does not exist for Contractor '04111'
                warning: []
                info: []
        '405':
          description: Method Not Allowed - Request method not supported
          content:
            application/json:
              example:
                timestamp: '2022-07-07T15:28:34.152Z'
                status: 405
                error: Method Not Allowed
        '503':
          description: Service Unavailable
  /contractors/regions:
    get:
      tags:
      - LCD
      summary: Medicare contractor region list
      operationId: getRegions
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Regions'
              example:
                region:
                - value: Alaska
                  regionCode: AK
                - value: Alabama
                  regionCode: AL
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Not Found - the data was not found
          content:
            application/json:
              example:
                error:
                - The requested resource does not exist.
                warning: []
                info: []
        '405':
          description: Method Not Allowed - Request method not supported
          content:
            application/json:
              example:
                timestamp: '2022-07-07T15:28:34.152Z'
                status: 405
                error: Method Not Allowed
        '503':
          description: Service Unavailable
components:
  schemas:
    RevenueCodes:
      type: object
      properties:
        codeInfo:
          type: array
          xml:
            name: code-info
          items:
            $ref: '#/components/schemas/CodeInfo'
    Contractor:
      required:
      - contractorName
      - contractorNumber
      - contractorPart
      - contractorType
      - regionCode
      - regionName
      type: object
      properties:
        regionCode:
          type: string
          xml:
            name: region-code
        regionName:
          type: string
          xml:
            name: region-name
        contractorName:
          type: string
          xml:
            name: contractor-name
        contractorPart:
          type: string
          xml:
            name: contractor-part
        contractorType:
          type: string
          xml:
            name: contractor-type
        contractorNumber:
          type: string
          xml:
            name: contractor-number
    Regions:
      type: object
      properties:
        region:
          type: array
          items:
            $ref: '#/components/schemas/Region'
      xml:
        name: regions
    TypeOfBillCodes:
      type: object
      properties:
        codeInfo:
          type: array
          xml:
            name: code-info
          items:
            $ref: '#/components/schemas/CodeInfo'
    ContractorPolicies:
      type: object
      properties:
        policy:
          type: array
          items:
            $ref: '#/components/schemas/Policy'
      xml:
        name: contractor-policies
    LcdCodingInformation:
      type: object
      properties:
        typeOfBillCodes:
          $ref: '#/components/schemas/TypeOfBillCodes'
        revenueCodes:
          $ref: '#/components/schemas/RevenueCodes'
        procedureCodes:
          $ref: '#/components/schemas/ProcedureCodes'
        diagnosticCodes:
          $ref: '#/components/schemas/DiagnosticCodes'
    Region:
      type: object
      properties:
        value:
          type: string
        regionCode:
          type: string
          xml:
            name: region-code
            attribute: true
    Policy:
      type: object
      properties:
        status:
          type: string
        effectiveDate:
          type: string
          xml:
            name: effective_date
        endDate:
          type: string
          xml:
            name: end_date
        title:
          type: string
        url:
          type: string
        code:
          type: string
        cmsId:
          type: string
          xml:
            attribute: true
    DiagnosticCodes:
      type: object
      properties:
        supportingMedicalNecessity:
          $ref: '#/components/schemas/SupportingMedicalNecessity'
        notSupportingMedicalNecessity:
          $ref: '#/components/schemas/NotSupportingMedicalNecessity'
    PolicyInfo:
      required:
      - effectiveDate
      - title
      - url
      type: object
      properties:
        title:
          type: string
        effectiveDate:
          type: string
          xml:
            name: effective-date
        expirationDate:
          type: string
          xml:
            name: expiration-date
        url:
          type: string
        contractorNum:
          type: string
          xml:
            name: contractor-num
            attribute: true
        cmsId:
          type: string
          xml:
            name: cms-id
            attribute: true
        contractorPart:
          type: string
          xml:
            name: contractor-part
            attribute: true
        contractorType:
          type: string
          xml:
            name: contractor-type
            attribute: true
        icpPolicyId:
          type: integer
          format: int32
        policyType:
          type: string
    SupportingMedicalNecessity:
      type: object
      properties:
        codeGroup:
          type: array
          xml:
            name: code-group
          items:
            $ref: '#/components/schemas/CodeGroup'
        numcodes:
          type: integer
          format: int32
          xml:
            attribute: true
        toomanycodes:
          type: boolean
          xml:
            attribute: true
    CodeGroup:
      type: object
      properties:
        paragraph:
          type: string
        codeInfo:
          type: array
          xml:
            name: code-info
          items:
            $ref: '#/components/schemas/CodeInfo'
    ContractorPolicyDetails:
      required:
      - policyInfo
      type: object
      properties:
        policyInfo:
          $ref: '#/components/schemas/PolicyInfo'
        ncdCodingInformation:
          $ref: '#/components/schemas/NcdCodingInformation'
        lcdCodingInformation:
          $ref: '#/components/schemas/LcdCodingInformation'
      xml:
        name: contractor-policy-details
    ContractorList:
      required:
      - contractor
      type: object
      properties:
        contractor:
          type: array
          items:
            $ref: '#/components/schemas/Contractor'
      xml:
        name: contractor-list
    NcdCodingInformation:
      type: object
      properties:
        procedureCodes:
          $ref: '#/components/schemas/ProcedureCodes'
        diagnosticCodes:
          $ref: '#/components/schemas/DiagnosticCodes'
    NotSupportingMedicalNecessity:
      type: object
      properties:
        codeGroup:
          type: array
          xml:
            name: code-group
          items:
            $ref: '#/components/schemas/CodeGroup'
        numcodes:
          type: integer
          format: int32
          xml:
            attribute: true
        toomanycodes:
          type: boolean
          xml:
            attribute: true
    ProcedureCodes:
      type: object
      properties:
        codeGroup:
          type: array
          xml:
            name: code-group
          items:
            $ref: '#/components/schemas/CodeGroup'
        numcodes:
          type: integer
          format: int32
          xml:
            attribute: true
        toomanycodes:
          type: boolean
          xml:
            attribute: true
    CodeInfo:
      required:
      - code
      - description
      type: object
      properties:
        code:
          type: string
        description:
          type: string
        type:
          type: string
          xml:
            attribute: true
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
    ws_auth:
      type: oauth2
      flows:
        authorizationCode:
          authorizationUrl: https://idx.linkhealth.com/auth
          tokenUrl: https://idx.linkhealth.com/auth/token
          scopes:
            scope-1: required scope for API access
x-readme:
  explorer-enabled: true
  proxy-enabled: true