Optum

Optum Medicare Policy API

The Medicare Policy API from Optum — 3 operation(s) for medicare policy.

Documentation GitHub OpenAPI

Operations 3

GET /codetype/{codetype}/{code}/medicarepolicy/{policytype}{contractortype} Get Medicare contractors info #

GET /codetype/{codetype}/{code}/medicarepolicy/{policytype}/{contractortype}/{contractornum} Medicare Policies Data #

GET /codetype/{codetype}/{code}/medicarepolicy Medicare Policies #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum Real-Time eContent Web services Medicare Policy 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: Medicare Policy
paths:
  /codetype/{codetype}/{code}/medicarepolicy/{policytype}{contractortype}:
    get:
      tags:
      - Medicare Policy
      summary: Get Medicare contractors info
      operationId: getContractorLinks
      parameters:
      - name: codetype
        in: path
        description: The codetype needed to identify the type of code
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
          - icd9v1
          - icd10cm
      - name: code
        in: path
        description: The code value for the respective codetype
        required: true
        schema:
          type: string
        example: 99213
      - name: policytype
        in: path
        description: Type of policy
        required: true
        schema:
          type: string
          enum:
          - lcd
          - ncd
      - name: contractortype
        in: path
        description: '<DL><DT>LCD policy contractor types: </DT><DD> ''fi'' - Part A Contractors (e.g. Fiscal Intermediary)</DD> <DD> ''ca'' - Part B Contractors (e.g. Carrier)</DD> <DD> ''all'' - list of all contractors </DD><DT>NCD policy contractor types:  </DT><DD> ''na'' - part A</DD> <DD> ''nb'' - part B</DD> <DD> ''all'' - includes part A and part B </DD></DL>'
        required: true
        schema:
          pattern: (/([all|fi|ca|nb|na],*)+)?
          type: string
          default: all
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Contractors'
              example:
                type:
                  link:
                  - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/all
                    value: ALL
                  - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/ca
                    value: CA
                  - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/fi
                    value: FI
        '400':
          description: Code does not exist
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Contractors'
              example:
                error:
                - Code '99999' does not exist
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: 'Wrong codetype '
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Contractors'
              example:
                error:
                - The code provided ('250.01') in this web service request is not a valid 'cpt' code.
                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
  /codetype/{codetype}/{code}/medicarepolicy/{policytype}/{contractortype}/{contractornum}:
    get:
      tags:
      - Medicare Policy
      summary: Medicare Policies Data
      operationId: getPolicies_1
      parameters:
      - name: codetype
        in: path
        description: The codetype needed to identify the type of code
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
          - icd9v1
          - icd10cm
      - name: code
        in: path
        description: The code value for the respective codetype
        required: true
        schema:
          type: string
        example: 83550
      - name: policytype
        in: path
        description: Type of policy
        required: true
        schema:
          type: string
          enum:
          - ncd
          - lcd
      - name: contractornum
        in: path
        description: A Valid 5 digit contractor number for LCD contractors or '0' for NCD contractors
        required: true
        schema:
          type: string
        example: 0
      - name: contractortype
        in: path
        description: 'Local Coverage Determination(LCD)<UL><LI>''ca''  : MAC Part B/Part B Carrier</LI><LI>''da''  : Durable Medical Equipment(DME) Contractor</LI><LI>''fi''  : MAC Part A/Part A Fiscal Intermediary</LI></UL>National Coverage Determination(NCD)<UL><LI>''na''  : Medicare Part A</LI><LI>''nb''  : Medicare Part B</LI><LI>''nd''  : Durable Medical Equipment(DME)</LI></UL>'
        required: true
        schema:
          pattern: fi|ca|da|nb|na|nd
          type: string
          default: nb
      - name: data
        in: query
        description: 'One of <UL><LI>''active'' : Retrieve only active policies </LI><LI>''includeretired'' :  Retrieve active and retired policies</LI></UL>'
        schema:
          type: string
          default: active
      - name: start
        in: query
        description: The index to start with
        schema:
          type: integer
          format: int32
          default: 0
      - name: maxresults
        in: query
        description: The maximum number od results to be returned
        schema:
          type: integer
          format: int32
          default: 100
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Policies'
              example:
                type:
                  link:
                  - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/all
                    value: ALL
                  - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/ca
                    value: CA
                  - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/fi
                    value: FI
        '400':
          description: '''Start'' value is negative'
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Policies'
              example:
                error:
                - '''start'' value is negative.'
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Code does not exist
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Policies'
              example:
                error:
                - Code '99999' 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
  /codetype/{codetype}/{code}/medicarepolicy:
    get:
      tags:
      - Medicare Policy
      summary: Medicare Policies
      operationId: getPolicyLinks
      parameters:
      - name: codetype
        in: path
        description: The codetype needed to identify the type of code
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
          - icd9v1
          - icd10cm
      - name: code
        in: path
        description: The code value for the respective codetype
        required: true
        schema:
          type: string
        example: 99213
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/Link'
              example:
              - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/all
                value: All LCD contractors
              - href: /ws/codetype/cpt/99213/medicarepolicy/lcd/fi
                value: FI (part A)
        '400':
          description: Wrong codetype
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/Link'
              example:
                error:
                - The code provided ('250.00') in this web service request is not a valid 'cpt' code.
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Code does not exist
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/Link'
              example:
                error:
                - Code '99999' 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:
    Link:
      type: object
      properties:
        href:
          type: string
          xml:
            attribute: true
        value:
          type: string
    Contractors:
      type: object
      properties:
        type:
          $ref: '#/components/schemas/Links'
        fi:
          $ref: '#/components/schemas/Links'
        ca:
          $ref: '#/components/schemas/Links'
        na:
          $ref: '#/components/schemas/Links'
        nb:
          $ref: '#/components/schemas/Links'
      xml:
        name: Contractors
    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
    Links:
      type: object
      properties:
        link:
          type: array
          xml:
            name: Link
          items:
            $ref: '#/components/schemas/Link'
    Policies:
      type: object
      properties:
        code:
          type: array
          items:
            $ref: '#/components/schemas/Code'
        link:
          type: array
          items:
            $ref: '#/components/schemas/Link'
      xml:
        name: policies
    Code:
      type: object
      properties:
        policy:
          type: array
          items:
            $ref: '#/components/schemas/Policy'
        value:
          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