Optum

Optum Medicare Coverage Policy for part A and Part B APIs API

The Medicare Coverage Policy for part A and Part B APIs API from Optum — 4 operation(s) for medicare coverage policy for part a and part b apis.

Documentation GitHub OpenAPI

Operations 4

GET /api/cms/{cmsType}/policy-list/ncd/{contractorPart}/{codetype}/{code} Fetches NCD Policies for particular Contractor part and Code (procedural or diagnosis) #

GET /api/cms/{cmsType}/policy-list/lcd/{contractorPart}/{codetype}/{code} Fetches LCD policies for particular contractor Id , contractor part and code (procedural or diagnosis) #

GET /api/cms/common/policy-list/ncd/{contractorPart} Fetches NCD Policies for particular Contractor part #

GET /api/cms/common/policy-list/lcd/{contractorPart} Fetches LCD policies for particular contractor id , contractor part #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum Medicare Coverage Policy for part A and Part B APIs API
  version: v1.0
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  description: 'Operations tagged Medicare Coverage Policy for part A and Part B 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: Medicare Coverage Policy for part A and Part B APIs
paths:
  /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: []
    servers:
    - url: /v1/cmscommonms
  /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: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/common/policy-list/ncd/{contractorPart}:
    get:
      tags:
      - Medicare Coverage Policy for part A and Part B APIs
      summary: Fetches NCD Policies for particular Contractor part
      operationId: getMedicareNCDPolicyList
      parameters:
      - name: contractorPart
        in: path
        required: true
        schema:
          type: string
          enum:
          - DME
          - B
          - A
          - LAB
      - 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
          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/A4575
      security:
      - bearerAuth: []
    servers:
    - url: /v1/cmscommonms
  /api/cms/common/policy-list/lcd/{contractorPart}:
    get:
      tags:
      - Medicare Coverage Policy for part A and Part B APIs
      summary: Fetches LCD policies for particular contractor id  , contractor part
      operationId: getMedicareLCDPolicyList
      parameters:
      - 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: is-retired-policies
        in: query
        required: false
        schema:
          type: boolean
          default: 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: Fetches LCD policies for particular contractor id , contractor part
          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?contractor_id=128
      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