Optum

Optum Revenue Codes API

The Revenue Codes API API from Optum — 4 operation(s) for revenue codes api.

GitHub OpenAPI

Operations 4

GET /api/optum/facility/revenue-procedure-cross-codes/{rev-code} Fetches procedure codes for corresponding revenue code #
GET /api/optum/facility/procedure-revenue-codes/{cpt-hcpcs-code} Fetches revenue codes for corresponding procedure code #
GET /api/optum/facility/cpt-hcpcs-required-revenue Fetches revenue codes requiring CPT HCPCS #
GET /api/optum/facility/all-revenue-codes Fetches all revenue codes table data #

Documentation

📖
APIReference
https://developer.optum.com/eligibilityandclaims/reference/api-overview
📖
GettingStarted
https://developer.optum.com/eligibilityandclaims/docs/get-started-with-optum-api
📖
Authentication
https://developer.optum.com/eligibilityandclaims/docs/optum-security-and-authorization
📖
APIReference
https://developer.optum.com/optumreal-dental/reference/overview-real-dental
📖
GettingStarted
https://developer.optum.com/optumreal-dental/reference/get-started
📖
APIReference
https://developer.optum.com/pharmacysolutions/reference
📖
APIReference
https://developer.optum.com/paymentandreimbursement/reference
📖
APIReference
https://developer.optum.com/platformandinteroperability/reference
📖
APIReference
https://developer.optum.com/analyticsandinsights/reference
📖
APIReference
https://developer.optum.com/apitools/reference/security-and-authorization-v2-overview
📖
Documentation
https://developer.optum.com/apitools/docs/getting-started

Specifications

⚙
OpenAPI
https://raw.githubusercontent.com/api-evangelist/optum/refs/heads/main/openapi/optum-revenue-codes-api-api-openapi.yml

Other Resources

🔗
ChangeLog
https://developer.optum.com/eligibilityandclaims/docs/eligibility-release-notes

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OpenAPI Specification

optum-revenue-codes-api-api-openapi.yml Raw ↑ 
openapi: 3.2.0
info:
  title: Optum Common Facility Revenue Codes API
  description: MicroService that contains Optum module-related information
  contact:
    name: Ken Kracker
    email: ken.kracker@optum.com
  version: v1.0
servers:
- url: /v1/optumcommonms
tags:
- name: Revenue Codes API
paths:
  /api/optum/facility/revenue-procedure-cross-codes/{rev-code}:
    get:
      tags:
      - Revenue Codes API
      summary: Fetches procedure codes for corresponding revenue code
      operationId: getProcCodesForRevenueCode
      parameters:
      - name: rev-code
        in: path
        description: Revenue Code
        required: true
        schema:
          type: string
        example: '0250'
      - 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: Fetches procedure codes for corresponding revenue code
          content:
            application/json:
              example:
                content:
                - code: A9270
                  description: Noncovered item or service
                  tobCode: '012'
                  tobDescription: Hospital Inpatient (Medicare Part B only)
                  note: 'For Medicare claims: This code may be used for items and services associated with an ABN that do not have specific HCPCS codes assigned. Report under any appropriate revenue code. Other payers: This code is by definition a noncovered item or service.'
                  codeType: hcpcs
                - code: A9270
                  description: Noncovered item or service
                  tobCode: '013'
                  tobDescription: Hospital Outpatient
                  note: 'For Medicare claims: This code may be used for items and services associated with an ABN that do not have specific HCPCS codes assigned. Report under any appropriate revenue code. Other payers: This code is by definition a noncovered item or service.'
                  codeType: hcpcs
                totalCount: 2
        '400':
          description: Bad request
          content:
            application/json:
              example:
                error:
                - sort parameter value should be from list of [code, -code]
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-27T08:10:07.573+00:00'
                status: 500
                error: Internal Server Error
                message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one'
                path: /optumcommonms/api/optum/facility/revenue-procedure-cross-codes/0255?page=-1
      security:
      - bearerAuth: []
  /api/optum/facility/procedure-revenue-codes/{cpt-hcpcs-code}:
    get:
      tags:
      - Revenue Codes API
      summary: Fetches revenue codes for corresponding procedure code
      operationId: getRevenueCodesForProcCode
      parameters:
      - name: cpt-hcpcs-code
        in: path
        description: Cpt or HCPCS Code
        required: true
        schema:
          type: string
        example: 99213
      - 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 (revenueCode,-revenueCode,tobCode,-tobCode) are allowed.
        required: false
        schema:
          type: array
          items:
            type: string
          default:
          - revenueCode
      - 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 revenue codes for corresponding procedure code
          content:
            application/json:
              example:
                content:
                - revenueCode: '0456'
                  revenueCodeDesc: Emergency Room-Urgent Care
                  tobCode: '013'
                  tobCodeDesc: Hospital Outpatient
                  note: Clinic or ED Visit. Paid a separate APC.
                - revenueCode: '0510'
                  revenueCodeDesc: Clinic-General classification
                  tobCode: '013'
                  tobCodeDesc: Hospital Outpatient
                  note: Clinic or ED Visit. Paid a separate APC.
                totalCount: 2
        '400':
          description: Bad request
          content:
            application/json:
              example:
                error:
                - sort parameter value should be from list of [revenueCode, -revenueCode, tobCode, -tobCode]
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-27T08:10:07.573+00:00'
                status: 500
                error: Internal Server Error
                message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one'
                path: /optumcommonms/api/optum/facility/procedure-revenue-codes/99213?page=-1
      security:
      - bearerAuth: []
  /api/optum/facility/cpt-hcpcs-required-revenue:
    get:
      tags:
      - Revenue Codes API
      summary: Fetches revenue codes requiring CPT HCPCS
      operationId: getCptHcpcsRequiredRevenueCodes
      parameters:
      - 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: Fetches revenue codes requiring CPT HCPCS
          content:
            application/json:
              example:
                content:
                - code: 0278
                  description: Medical/Surgical Supplies and Devices
                  hasProcedureCodes: true
                  rangeDescription: Ancillary Services
                  subCategoryAbbr: SUPPLY/IMPLANTS
                  subCategoryDes: Other Implants
                - code: 0291
                  description: Durable Medical Equipment (Other than renal)
                  hasProcedureCodes: true
                  rangeDescription: Ancillary Services
                  subCategoryAbbr: DME-RENTAL
                  subCategoryDes: Rental
                totalCount: 2
        '400':
          description: Bad request
          content:
            application/json:
              example:
                error:
                - sort parameter value should be from list of [code, -code]
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-27T08:10:07.573+00:00'
                status: 500
                error: Internal Server Error
                message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one'
                path: /optumcommonms/api/optum/facility/cpt-hcpcs-required-revenue?page=-1
      security:
      - bearerAuth: []
  /api/optum/facility/all-revenue-codes:
    get:
      tags:
      - Revenue Codes API
      summary: Fetches all revenue codes table data
      operationId: getAllRevenueCodes
      parameters:
      - 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: Fetches all revenue codes table data
          content:
            application/json:
              example:
                content:
                - code: '0000'
                  description: Reserved
                  hasProcedureCodes: false
                - code: '0001'
                  description: Total Charges (reportable on paper claims only)
                  hasProcedureCodes: false
                totalCount: 1232
        '400':
          description: Bad request
          content:
            application/json:
              example:
                error:
                - sort parameter value should be from list of [code, -code]
                warning: null
                info: null
        '500':
          description: Internal server error
          content:
            application/json:
              example:
                timestamp: '2023-07-27T08:10:07.573+00:00'
                status: 500
                error: Internal Server Error
                message: 'Request processing failed: java.lang.IllegalArgumentException: Page size must not be less than one'
                path: /optumcommonms/api/optum/facility/all-revenue-codes?page=-1
      security:
      - bearerAuth: []
components:
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
x-readme:
  explorer-enabled: true
  proxy-enabled: true