pVerify Patient Cost Estimator API

openapi: 3.2.0
info:
  title: pVerify Patient Cost Estimator Estimation API
  description: pVerify Patient Cost Estimator API, derived operation-for-operation from the public Postman collection pVerify publishes at https://postman.pverify.com/ (last updated 03/01/2026). All calls require an OAuth2 bearer token from POST /Token plus the Client-API-Id header.
  version: '1.0'
  termsOfService: https://pverify.com/privacy-policy/
  contact:
    name: pVerify Support
    email: support@pverify.com
    url: https://pverify.com/contact-support/
servers:
- url: https://api.pverify.com
  description: Production
- url: https://testapi.pverify.com
  description: Test environment published by pVerify
tags:
- name: Estimation
paths:
  /api/EstimateCalculation:
    post:
      operationId: estimateCalculation
      tags:
      - Estimation
      summary: EstimateCalculation
      description: "Environment | \nURL | \n\nProduction | \nhttps://api.pverify.com/api/EstimateCalculation | \n\nThis POST call will get an estimated price from CMS (Medicare) non-facility price index. In order for you to use this, we must add the estimator service (which is free) to your account. Additionally, for the Zip code, use 0 for national pricing, and you can send an array of CPT codes per the Postman example. Please note, due to the nature of the EstimateCalculation call, no test credentials are available.\n\nEstimateCalculation Request\n\nKey | \nValue | \n\nURL | \nhttps://api.pverify.com/api/EstimateCalculation | \n\nMethod | \nPOST | \n\nHeaders | \nDescription | \n\nClient-API-Id* | \nYour pVerify client-api-id | \n\nContent-Type | \napplication/json | \n\nBody | \nDescription | \n\nData Parameters | \nSee fields to the right | \n\n*Note: The Client-API-Id is required in header. Header keys are case sensitive.\n\nEstimateCalculation Request Fields\n\nField | \nType | \nDescription | \n\nzipCode | \nString | \nZip code of your location. Use 0 for national pricing. | \n\ncptCodes | \nString | \nArray of CPT codes needed for estimate. If there is a modifier include it as a dash. For example, 93024-TC would be the cardiac drug stress test technical component. | \n\ncoPay | \nString | \nDollar amount of patient copay. | \n\ncoinsPercentage | \nString | \nIn percent, coinsurance | \n\ndeductibleRemaining | \nString | \nDollar amount of deductible remaining | \n\noutofPocketRemaining | \nString | \nOut of pocket remaining- if this is blank we will not include this in the calculation. | \n\nisCopayIncludeInDeductible | \nBoolean | \nAdd copay to coinsurance or not. | \n\nisSecondaryStatusActive | \nBoolean | \nIf patient has secondary insurance- if this is true then patient responsibility is zero. | \n\nNonMedicareMultipleFactor | \nDecimal | \nNonMedicare Multiple factor to CPT values calculation | \n\nInternalId | \nString | \nInternal Id for patient | \n\nEstimateCalculation Response\n\nField | \nDescription | \n\npatientResponsibility | \nThe amount the patient owes. | \n\ncopay | \nPatient copay. | \n\ncoInsPercentage | \nCoinsurance percentage. | \n\ncoInsAmount | \nCoinsurance Amount. | \n\nestimatedAllowable | \nTHe sum of the charges (note: not all charges are approved by CMS) | \n\ndeductibleRemainging | \nAmount of deductible remaining.+ | \n\noutOfPocketRemaining | \nAmount remaining for out of pocket.++ | \n\namountPayable | \nAmount Payable | \n\nselected CPTs | \nSelected CPT codes | \n\nzipCode | \nZip code returned | \n\napiResponseCode | \nAPI response code | \n\napiResponseMessage | \nAPI response message | \n\nInternalId | \nInternal Id for patient | \n\n+The deductible must be met before insurance applies. For example, if the deductible remaining is 1000, then the patient will have to pay out of pocket $1000 for next procedure as long as the procedure amount > $1000.++This is typically a high number. Once it reaches zero, the patient responsibility is zero. It is designed for catastrophic coverage ie: major surgery or chemotherapy."
      requestBody:
        required: true
        content:
          application/json:
            schema:
              type: object
              properties:
                zipCode:
                  type: string
                  example: '27713'
                cptCodes:
                  type: array
                  items:
                    type: string
                    example: '10061'
                coPay:
                  type: string
                  example: '20'
                coinsPercentage:
                  type: string
                  example: '30'
                deductibleRemaining:
                  type: string
                  example: '40'
                outofPocketRemaining:
                  type: string
                isCopayIncludeInDeductible:
                  type: boolean
                  example: false
                isSecondryStatusActive:
                  type: boolean
                  example: false
                NonMedicareMultipleFactor:
                  type: number
                  example: 1.2
                InternalId: {}
            example:
              zipCode: '27713'
              cptCodes:
              - '10061'
              - 0191T
              - '33300'
              coPay: '20'
              coinsPercentage: '30'
              deductibleRemaining: '40'
              outofPocketRemaining: ''
              isCopayIncludeInDeductible: false
              isSecondryStatusActive: false
              NonMedicareMultipleFactor: 1.2
              InternalId: null
      responses:
        '200':
          description: OK
      security:
      - bearerAuth: []
        clientApiId: []
components:
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: 'OAuth2 access token returned by POST /Token, sent as `Authorization: Bearer <token>`.'
    clientApiId:
      type: apiKey
      in: header
      name: Client-API-Id
      description: Client API identifier issued by pVerify. Required on every call; header keys are case sensitive.
    clientSecret:
      type: apiKey
      in: header
      name: Client-Secret
      description: Client secret issued by pVerify, used by the one-step (no-token) endpoints and the premium report endpoints.