Optum

Optum Modifiers API

The Modifiers API from Optum — 5 operation(s) for modifiers.

Documentation GitHub OpenAPI

Business capability

Medical Coding Management BC-2870.20

Operations 5

GET /codetype/{codetype}/allmodifiers Return all the Modifiers for the supplied {codeype} #

GET /modifier-51-exempt Returns the list of Optum/AMA Modifier -51 Exempt codes #

GET /codetype/{codetype}/modifier/{modifier} Return codes and properties for the supplied {modifier} and {codetype} #

GET /codetype/modifier/{code}/properties Show properties for modifier Code #

GET /codetype/{codetype}/{code}/modifiers Return Modifiers for the supplied {code}. If you want additional information please supply additional query parameters #

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OpenAPI Specification

openapi: 3.2.0
info:
  title: Optum Real-Time eContent Web services Modifiers 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: Modifiers
paths:
  /codetype/{codetype}/allmodifiers:
    get:
      tags:
      - Modifiers
      summary: Return all the Modifiers for the supplied {codeype}
      operationId: getModifiers
      parameters:
      - name: codetype
        in: path
        description: The codetype needed to identify the type of code
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/Link'
              example:
              - href: /ws/codetype/cpt/modifier/1P?types=all&data=all
                value: 1P
              - href: /ws/codetype/cpt/modifier/22?types=all&data=all
                value: '22'
        '400':
          description: Invalid parameter passed
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/Link'
              example:
                error:
                - The code provided ('ALLMODIFIERS=CMS2') in this web service request is not a valid 'hcpcs' code.
                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
  /modifier-51-exempt:
    get:
      tags:
      - Modifiers
      summary: Returns the list of Optum/AMA Modifier -51 Exempt codes
      operationId: getOptumAmaMod51Exempt
      parameters:
      - name: types
        in: query
        description: 'Comma seperated list of<UL> <LI>optum : Optum -51 Exempt Modifiers </LI><LI>ama : AMA -51 Exempt Modifiers </LI></UL>'
        schema:
          type: string
          default: optum,ama
        example: optum,ama
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Modifier51Exempt'
              example:
                optum360:
                - code: '90281'
                  description: Immune globulin (Ig), human, for intramuscular use
                - code: '90283'
                  description: Immune globulin (IgIV), human, for intravenous use
        '400':
          description: Bad Types Parameter
          content:
            application/json:
              schema:
                type: array
                items:
                  $ref: '#/components/schemas/Modifier51Exempt'
              example:
                error:
                - Bad types parameter 'bad'
                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
  /codetype/{codetype}/modifier/{modifier}:
    get:
      tags:
      - Modifiers
      summary: Return codes and properties for the supplied {modifier} and {codetype}
      operationId: getProperty_2
      parameters:
      - name: codetype
        in: path
        description: The codetype needed to identify the type of code
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
      - name: modifier
        in: path
        description: The modifier for a particular code
        required: true
        schema:
          type: string
        example: 24
      - name: data
        in: query
        description: 'Comma seperated list of<UL><LI>desc : e.g. SDHD (hereditary paraganglioma)</LI><LI>usage : eg. (Genetic testing code modifier. First digit is the disease category and the second is the gene type. Report only when required by the payer. Genetic code modifiers may be reported with CPT codes 83890-83916, 88230-88299 or other molecular and cytogenic studies.)</LI><LI>def : eg. The unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).</LI><LI>source : eg. CMS Policy</LI><LI>sourcing_rationale : eg. Sourcing Rationale: 589 Current Procedural Terminology (CPT) Level I Modifiers and Healthcare Common Procedure Coding System (HCPCS) Level II modifiers are appended to Level I or Level II Codes based on information from the Centers.... (can be long)</LI><LI>all : All of the above data.</LI></UL>'
        schema:
          type: string
          default: desc
        example: desc,usage
      - name: types
        in: query
        description: 'comma seperated list of<UL> <LI>physician : Physician modifiers</LI><LI>facility : Facility modifiers</LI><LI>opps : Facility modifiers with OPPS</LI><LI>asc : ASC Payment modifiers</LI><LI>mpfs : MPFS/Medicare modifiers</LI><LI>ambulance: CMS Ambulatory modifiers</LI><LI>dme: CMS Durable Medical Equipment modifiers</LI><LI>all: all modifiers</LI></UL>'
        schema:
          type: string
          default: physician
        example: physician,facility
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModifierProperty'
              example:
                description: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
                physician:
                  link:
                  - href: /ws/codetype/cpt/92002
                    value: '92002'
                  - href: /ws/codetype/cpt/92004
                    value: '92004'
        '400':
          description: Unknown Type Element
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModifierProperty'
              example:
                error:
                - 'Unknown types element : faccility'
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Code not found for modifier entered
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModifierProperty'
              example:
                error: []
                warning: []
                info:
                - Code not found for the modifier entered.
        '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/modifier/{code}/properties:
    get:
      tags:
      - Modifiers
      summary: Show properties for modifier Code
      operationId: getProperty_3
      parameters:
      - name: code
        in: path
        description: The modifier code to search
        required: true
        schema:
          type: string
        example: 22
      - name: data
        in: query
        description: 'desc-full : full description'
        schema:
          type: string
          default: desc-full
        example: desc-full
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModifierDesc'
              example:
                descFull: Increased Procedural Services
        '400':
          description: Bad data parameter
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModifierDesc'
              example:
                error:
                - Bad data parameter 'bad'
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: No modifier code description found
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/ModifierDesc'
              example:
                error: []
                warning: []
                info:
                - No modifier code description found for the given modifier code you entered.
        '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}/modifiers:
    get:
      tags:
      - Modifiers
      summary: Return Modifiers for the supplied {code}. If you want additional information please supply additional query parameters
      operationId: getModifiers_1
      parameters:
      - name: codetype
        in: path
        description: The codetype needed to identify the type of code
        required: true
        schema:
          type: string
          enum:
          - cpt
          - hcpcs
      - name: code
        in: path
        description: The code value for the respective codetype
        required: true
        schema:
          type: string
        example: 93886
      - name: types
        in: query
        description: 'Comma seperated list of<UL> <LI>physician : Physician modifiers (default)<LI>facility : Facility modifiers</LI><LI>opps : Facility modifiers with OPPS</LI><LI>mpfs : MPFS/Medicare modifiers</LI><LI>asc: ASC Payment modifiers</LI><LI>ambulance: CMS Ambulatory modifiers</LI><LI>dme: CMS Durable Medical Equipment modifiers</LI><LI>all: all modifiers</LI></UL>'
        schema:
          type: string
          default: physician
        example: physician
      responses:
        '200':
          description: Successful Response
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Modifiers'
              example:
                physician:
                  link:
                  - href: /ws/codetype/cpt/modifier/93886
                    value: '22'
                  - href: /ws/codetype/cpt/modifier/93886
                    value: '23'
        '400':
          description: Bad data parameter
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Modifiers'
              example:
                error:
                - 'Unknown data element : faccility'
                warning: []
                info: []
        '401':
          description: Not Authorized
          content:
            application/json:
              example:
                timestamp: '2022-07-06T16:34:39.385Z'
                error: Unauthorized
                status: 401
        '404':
          description: Modifiers not found for the code entered
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Modifiers'
              example:
                error: []
                warning: []
                info:
                - Modifiers not found for the code entered.
        '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
    ModifierProperty:
      required:
      - sources
      type: object
      properties:
        description:
          type: string
        definition:
          type: string
        usage:
          type: string
        sources:
          $ref: '#/components/schemas/Sources'
        physician:
          $ref: '#/components/schemas/Links'
        facility:
          $ref: '#/components/schemas/Links'
        opps:
          $ref: '#/components/schemas/Links'
        asc:
          $ref: '#/components/schemas/Links'
        ambulance:
          $ref: '#/components/schemas/Links'
        dme:
          $ref: '#/components/schemas/Links'
        mpfs:
          $ref: '#/components/schemas/Links'
      xml:
        name: modifier-property
    ModifierDesc:
      type: object
      properties:
        descFull:
          type: string
          xml:
            name: desc-full
        usage:
          type: string
        definition:
          type: string
      xml:
        name: code-properties
    SourceRationale:
      type: object
      properties:
        value:
          type: string
        type:
          type: string
          xml:
            attribute: true
    Links:
      type: object
      properties:
        link:
          type: array
          xml:
            name: Link
          items:
            $ref: '#/components/schemas/Link'
    Ama:
      type: object
      properties:
        code:
          type: string
        description:
          type: string
    Modifier51Exempt:
      required:
      - ama
      - optum360
      type: object
      properties:
        optum360:
          type: array
          items:
            $ref: '#/components/schemas/Optum360'
        ama:
          type: array
          items:
            $ref: '#/components/schemas/Ama'
      xml:
        name: modifier-51-exempt
    Sources:
      required:
      - source
      - sourceRationale
      type: object
      properties:
        source:
          type: array
          items:
            $ref: '#/components/schemas/Source'
        sourceRationale:
          type: array
          xml:
            name: source_rationale
          items:
            $ref: '#/components/schemas/SourceRationale'
    Source:
      type: object
      properties:
        value:
          type: string
        type:
          type: string
          xml:
            attribute: true
    Optum360:
      type: object
      properties:
        code:
          type: string
        description:
          type: string
    Modifiers:
      type: object
      properties:
        physician:
          $ref: '#/components/schemas/Links'
        facility:
          $ref: '#/components/schemas/Links'
        opps:
          $ref: '#/components/schemas/Links'
        mpfs:
          $ref: '#/components/schemas/Links'
        asc:
          $ref: '#/components/schemas/Links'
        ambulance:
          $ref: '#/components/schemas/Links'
        dme:
          $ref: '#/components/schemas/Links'
      xml:
        name: modifiers
  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