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GET
Calculate payment for a code

Authorizations

X-API-Key
string
header
required

Path Parameters

code
string
required

Billing or terminology code value (CPT/HCPCS/NDC/etc depending on endpoint context).

Query Parameters

ccn
string | null

CCN — drives facility-aware composition

modifier
string | null

Optional HCPCS modifier (e.g. 26, TC, LT)

date_of_service
string | null

ISO date — reserved for future fee-schedule versioning

qpp
boolean
default:true

Use QPP conversion factor (True) or non-QPP (False)

qpp_ind
integer | null

0=non-QPP, 1=QPP — overrides qpp when supplied

locality
string | null

GPCI locality override (legacy; ignored when ccn is set)

place_of_service
string | null

POS code (e.g. 11 office, 22 on-campus outpatient). Pins the facility vs non-facility PE-RVU choice; overrides facility_type/CCN defaults.

facility
boolean
default:true

Legacy: use facility PE rate when no CCN is supplied

Response

Successful Response

Multi-block payment composition for a HCPCS / CPT code at a facility.

When ccn is provided, the response is composed against the facility's geography (LOCCO → GPCI, CBSA → wage_index). When omitted, only the physician block is populated using the supplied locality query param (legacy GPCI-only behavior).

applicable_blocks lists which sub-blocks have data — drives display on the consuming UI.

code
string
required
conversion_factor
number
required
applicable_blocks
string[]
ccn
string | null
date_of_service
string | null
dme
DMEPaymentBlock · object | null

DMEPOS payment — picks rural vs non-rural rate by facility flag.

estimated_payment
number | null
facility
FacilityContextBlock · object | null

Facility context used to drive payment composition.

facility_rate
boolean | null
lab
LabPaymentBlock · object | null

Clinical Lab Fee Schedule payment (national rate, no geographic adjustment).

locality
string | null
mp_gpci
number | null
mp_rvu_adjusted
number | null
outpatient_facility
FacilityPaymentBlock · object | null

OPPS / outpatient hospital facility payment block.

payment = (rate * 0.6 * wage_index) + (rate * 0.4)

pe_gpci
number | null
pe_rvu_adjusted
number | null
physician
PhysicianPaymentBlock · object | null

MPFS payment block — work + PE + MP, GPCI-adjusted, then * conversion factor.

policy_rules
PolicyRuleResponse · object[]
pw_gpci
number | null
qpp
boolean
default:true

QPP-participating conversion factor used

reliability
ReliabilityMetadata · object

User-visible reliability metadata for this payment composition.

total_adjusted_rvu
number | null
work_rvu_adjusted
number | null