> ## Documentation Index > Fetch the complete documentation index at: https://docs.rcintell.com/llms.txt > Use this file to discover all available pages before exploring further. # Calculate payment for a code > Compose payment for a code at a CCN. Returns up to four blocks — ``physician`` (MPFS), ``outpatient_facility`` (OPPS with wage index), ``lab`` (CLFS), and ``dme`` (DMEPOS) — populated based on which fee schedules carry the code. Logic for each block: * **physician** — ``allowed = ((work*pw_gpci) + (pe*pe_gpci) + (mp*mp_gpci)) * CF`` where ``CF`` is QPP (33.5675) or non-QPP (33.4009) for 2026 and ``pe`` is the facility or non-facility PE-RVU based on the CCN's facility_type. * **outpatient_facility** — ``allowed = (rate*0.6*wage_index) + (rate*0.4)`` using the FY26 wage index for the facility's CBSA. * **lab** — flat CLFS rate (national, no geographic adjustment). * **dme** — rural or non-rural rate based on the facility's ``is_rural`` flag. ## OpenAPI ````yaml /docs/openapi.client.json get /v1/codes/{code}/payment openapi: 3.1.0 info: description: >- Client API for RCIntel. Admin ingest, catalog sync, and internal audit routes are omitted. See Guides → Which API to use. summary: Multi-tenant knowledge API for healthcare revenue cycle management. title: Healthcare Knowledge Layer version: 0.1.0 servers: [] security: [] tags: - description: >- Geographic payer policy lookup (national NCD vs MAC LCD vs state). Query payer, code, state, plan_type. Each row includes geo_scope and document_version. name: policies - description: >- Payer network directory — search payers, check prior auth requirements, view filing rules, denial patterns, and appeal levels. name: payers - description: >- Resolve healthcare billing knowledge across the L1-L6 layer stack. Includes payment calculation, billing guidance, and per-layer queries. name: knowledge - description: >- CMS Fee Schedule lookups — OPPS (Addendum B / APC), DMEPOS (state-level pricing), and Clinical Lab Fee Schedule (CLFS). name: fee-schedules - description: >- NCCI (National Correct Coding Initiative) — dedicated MUE limits, PTP bundling edits, add-on code edits, and code pair validation. name: ncci - description: >- Service code intelligence — CPT/HCPCS lookup, RVU data, NCCI edits, payment calculation, implant/GUDID search, and service group classification. name: codes - description: >- Submit asynchronous AI agent jobs for code research, medical necessity, and denial resolution. Poll for results and retrieve reasoning traces. name: agents - description: >- Register and manage healthcare facilities by CCN (Medicare Provider Number). Each facility is the root entity for knowledge resolution. name: facilities - description: >- NPI Registry — live search against CMS NPPES API for provider and organization National Provider Identifiers. name: npi - description: >- OpenFDA drug product lookup by NDC. Includes product-level fields with normalized ingredient and package detail. name: drugs - description: Health checks, service metadata, and Prometheus metrics. name: system paths: /v1/codes/{code}/payment: get: tags: - codes summary: Calculate payment for a code description: >- Compose payment for a code at a CCN. Returns up to four blocks — ``physician`` (MPFS), ``outpatient_facility`` (OPPS with wage index), ``lab`` (CLFS), and ``dme`` (DMEPOS) — populated based on which fee schedules carry the code. Logic for each block: * **physician** — ``allowed = ((work*pw_gpci) + (pe*pe_gpci) + (mp*mp_gpci)) * CF`` where ``CF`` is QPP (33.5675) or non-QPP (33.4009) for 2026 and ``pe`` is the facility or non-facility PE-RVU based on the CCN's facility_type. * **outpatient_facility** — ``allowed = (rate*0.6*wage_index) + (rate*0.4)`` using the FY26 wage index for the facility's CBSA. * **lab** — flat CLFS rate (national, no geographic adjustment). * **dme** — rural or non-rural rate based on the facility's ``is_rural`` flag. operationId: calculate_code_payment_v1_codes__code__payment_get parameters: - description: >- Billing or terminology code value (CPT/HCPCS/NDC/etc depending on endpoint context). in: path name: code required: true schema: title: Code type: string - description: CCN — drives facility-aware composition in: query name: ccn required: false schema: anyOf: - type: string - type: 'null' description: CCN — drives facility-aware composition title: Ccn - description: Optional HCPCS modifier (e.g. 26, TC, LT) in: query name: modifier required: false schema: anyOf: - type: string - type: 'null' description: Optional HCPCS modifier (e.g. 26, TC, LT) title: Modifier - description: ISO date — reserved for future fee-schedule versioning in: query name: date_of_service required: false schema: anyOf: - type: string - type: 'null' description: ISO date — reserved for future fee-schedule versioning title: Date Of Service - description: Use QPP conversion factor (True) or non-QPP (False) in: query name: qpp required: false schema: default: true description: Use QPP conversion factor (True) or non-QPP (False) title: Qpp type: boolean - description: 0=non-QPP, 1=QPP — overrides qpp when supplied in: query name: qpp_ind required: false schema: anyOf: - type: integer - type: 'null' description: 0=non-QPP, 1=QPP — overrides qpp when supplied title: Qpp Ind - description: GPCI locality override (legacy; ignored when ccn is set) in: query name: locality required: false schema: anyOf: - type: string - type: 'null' description: GPCI locality override (legacy; ignored when ccn is set) title: Locality - description: >- POS code (e.g. 11 office, 22 on-campus outpatient). Pins the facility vs non-facility PE-RVU choice; overrides facility_type/CCN defaults. in: query name: place_of_service required: false schema: anyOf: - type: string - type: 'null' description: >- POS code (e.g. 11 office, 22 on-campus outpatient). Pins the facility vs non-facility PE-RVU choice; overrides facility_type/CCN defaults. title: Place Of Service - description: 'Legacy: use facility PE rate when no CCN is supplied' in: query name: facility required: false schema: default: true description: 'Legacy: use facility PE rate when no CCN is supplied' title: Facility type: boolean responses: '200': content: application/json: schema: $ref: '#/components/schemas/CodePaymentResponse' description: Successful Response '422': content: application/json: schema: $ref: '#/components/schemas/HTTPValidationError' description: Validation Error security: - APIKeyHeader: [] components: schemas: CodePaymentResponse: description: >- 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. properties: applicable_blocks: items: type: string title: Applicable Blocks type: array ccn: anyOf: - type: string - type: 'null' title: Ccn code: title: Code type: string conversion_factor: title: Conversion Factor type: number date_of_service: anyOf: - type: string - type: 'null' title: Date Of Service dme: anyOf: - $ref: '#/components/schemas/DMEPaymentBlock' - type: 'null' estimated_payment: anyOf: - type: number - type: 'null' title: Estimated Payment facility: anyOf: - $ref: '#/components/schemas/FacilityContextBlock' - type: 'null' facility_rate: anyOf: - type: boolean - type: 'null' title: Facility Rate lab: anyOf: - $ref: '#/components/schemas/LabPaymentBlock' - type: 'null' locality: anyOf: - type: string - type: 'null' title: Locality mp_gpci: anyOf: - type: number - type: 'null' title: Mp Gpci mp_rvu_adjusted: anyOf: - type: number - type: 'null' title: Mp Rvu Adjusted outpatient_facility: anyOf: - $ref: '#/components/schemas/FacilityPaymentBlock' - type: 'null' pe_gpci: anyOf: - type: number - type: 'null' title: Pe Gpci pe_rvu_adjusted: anyOf: - type: number - type: 'null' title: Pe Rvu Adjusted physician: anyOf: - $ref: '#/components/schemas/PhysicianPaymentBlock' - type: 'null' policy_rules: items: $ref: '#/components/schemas/PolicyRuleResponse' title: Policy Rules type: array pw_gpci: anyOf: - type: number - type: 'null' title: Pw Gpci qpp: default: true description: QPP-participating conversion factor used title: Qpp type: boolean reliability: $ref: '#/components/schemas/ReliabilityMetadata' description: User-visible reliability metadata for this payment composition. total_adjusted_rvu: anyOf: - type: number - type: 'null' title: Total Adjusted Rvu work_rvu_adjusted: anyOf: - type: number - type: 'null' title: Work Rvu Adjusted required: - code - conversion_factor title: CodePaymentResponse type: object HTTPValidationError: properties: detail: items: $ref: '#/components/schemas/ValidationError' title: Detail type: array title: HTTPValidationError type: object DMEPaymentBlock: description: DMEPOS payment — picks rural vs non-rural rate by facility flag. properties: allowed_dme_payment: title: Allowed Dme Payment type: number dme_payment_rate: title: Dme Payment Rate type: number is_rural: default: false title: Is Rural type: boolean rate_used: default: non_rural description: '''rural'' or ''non_rural''' title: Rate Used type: string state: anyOf: - type: string - type: 'null' title: State required: - dme_payment_rate - allowed_dme_payment title: DMEPaymentBlock type: object FacilityContextBlock: description: Facility context used to drive payment composition. properties: cbsa: anyOf: - type: string - type: 'null' title: Cbsa ccn: title: Ccn type: string county: anyOf: - type: string - type: 'null' title: County facility_type: anyOf: - type: string - type: 'null' title: Facility Type is_rural: anyOf: - type: boolean - type: 'null' title: Is Rural locality_name: anyOf: - type: string - type: 'null' title: Locality Name locality_number: anyOf: - type: string - type: 'null' title: Locality Number name: anyOf: - type: string - type: 'null' title: Name pos_code: anyOf: - type: string - type: 'null' title: Pos Code registered: default: true description: >- True when geography came from a facility registered to the tenant (county-precise locality + CBSA wage index). False when it was derived from the raw CCN (state-level 'Rest of State' locality; no CBSA wage index). title: Registered type: boolean state: anyOf: - type: string - type: 'null' title: State wage_index: anyOf: - type: number - type: 'null' title: Wage Index required: - ccn title: FacilityContextBlock type: object LabPaymentBlock: description: >- Clinical Lab Fee Schedule payment (national rate, no geographic adjustment). properties: allowed_lab_payment: title: Allowed Lab Payment type: number indicator: anyOf: - type: string - type: 'null' title: Indicator lab_payment_rate: title: Lab Payment Rate type: number required: - lab_payment_rate - allowed_lab_payment title: LabPaymentBlock type: object FacilityPaymentBlock: description: |- OPPS / outpatient hospital facility payment block. payment = (rate * 0.6 * wage_index) + (rate * 0.4) properties: allowed_fac_payment: title: Allowed Fac Payment type: number apc_code: anyOf: - type: string - type: 'null' title: Apc Code labor_share: default: 0.6 title: Labor Share type: number non_labor_share: default: 0.4 title: Non Labor Share type: number opps_payment_rate: title: Opps Payment Rate type: number relative_weight: anyOf: - type: number - type: 'null' title: Relative Weight status_indicator: anyOf: - type: string - type: 'null' title: Status Indicator wage_index: default: 1 title: Wage Index type: number required: - opps_payment_rate - allowed_fac_payment title: FacilityPaymentBlock type: object PhysicianPaymentBlock: description: >- MPFS payment block — work + PE + MP, GPCI-adjusted, then * conversion factor. properties: allowed_phy_payment: title: Allowed Phy Payment type: number conversion_factor: title: Conversion Factor type: number mp_gpci: title: Mp Gpci type: number mp_rvu: title: Mp Rvu type: number mp_rvu_adjusted: title: Mp Rvu Adjusted type: number pe_gpci: title: Pe Gpci type: number pe_rvu: description: fac_pe_rvu when facility, otherwise non_fac_pe_rvu title: Pe Rvu type: number pe_rvu_adjusted: title: Pe Rvu Adjusted type: number pe_rvu_source: default: facility description: 'Which PE RVU was used: ''facility'' or ''non_facility''' title: Pe Rvu Source type: string pw_gpci: title: Pw Gpci type: number rvu_quarter: anyOf: - type: integer - type: 'null' description: >- CMS fee-schedule quarter (1-4) of the RVU row used, when the source tracks quarters. title: Rvu Quarter rvu_source: default: postgres description: >- Backend the RVUs were read from: 'postgres' (legacy seed) or 'clickhouse' (mart_fee_schedule). title: Rvu Source type: string rvu_year: anyOf: - type: integer - type: 'null' description: CMS fee-schedule year of the RVU row used for this calculation. title: Rvu Year total_adjusted_rvu: title: Total Adjusted Rvu type: number work_rvu: title: Work Rvu type: number work_rvu_adjusted: title: Work Rvu Adjusted type: number required: - pw_gpci - pe_gpci - mp_gpci - work_rvu - pe_rvu - mp_rvu - work_rvu_adjusted - pe_rvu_adjusted - mp_rvu_adjusted - total_adjusted_rvu - conversion_factor - allowed_phy_payment title: PhysicianPaymentBlock type: object PolicyRuleResponse: description: Policy-rule evidence extracted from CMS transmittals and linked by code. properties: action: anyOf: - type: string - type: 'null' title: Action change_type: anyOf: - type: string - type: 'null' title: Change Type code: title: Code type: string discovery_depth: default: 0 title: Discovery Depth type: integer doc_id: title: Doc Id type: string effective_from: anyOf: - type: string - type: 'null' title: Effective From kind: title: Kind type: string license_kind: default: public title: License Kind type: string lineage_root_doc_id: anyOf: - type: string - type: 'null' title: Lineage Root Doc Id parent_doc_id: anyOf: - type: string - type: 'null' title: Parent Doc Id pdf_uri: title: Pdf Uri type: string rule_text: title: Rule Text type: string source_key: title: Source Key type: string trigger_condition: anyOf: - type: string - type: 'null' title: Trigger Condition required: - code - source_key - doc_id - pdf_uri - kind - rule_text title: PolicyRuleResponse type: object ReliabilityMetadata: description: User-visible reliability metadata attached to API responses. properties: data_sources: additionalProperties: type: string description: Data-source backends used to build this response. title: Data Sources type: object dataset_versions: additionalProperties: type: string description: >- CMS/DHCS/NLM/FDA named versions used to compose this response (e.g. mpfs=CY2026, ipps=FY2026). See GET /v1/data/changes. title: Dataset Versions type: object degraded: default: false description: True when a fallback or non-primary source path was used. title: Degraded type: boolean generated_at: description: UTC timestamp when the response payload was composed. title: Generated At type: string warnings: description: Human-readable caveats relevant to downstream consumers. items: type: string title: Warnings type: array required: - generated_at title: ReliabilityMetadata type: object ValidationError: properties: ctx: title: Context type: object input: title: Input loc: items: anyOf: - type: string - type: integer title: Location type: array msg: title: Message type: string type: title: Error Type type: string required: - loc - msg - type title: ValidationError type: object securitySchemes: APIKeyHeader: in: header name: X-API-Key type: apiKey ````