> ## 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. # LCD/NCD medical-necessity coverage check > Coverage-only medical-necessity check: match each procedure's diagnoses against the applicable Medicare local (LCD) and national (NCD) coverage determinations, localized by state → MAC jurisdiction. Does not run NCCI, MUE, timely filing, or payment. ## OpenAPI ````yaml /docs/openapi.client.json post /v1/encounter/coverage openapi: 3.1.0 info: description: >- Client API for RCIntel. Authenticate with X-API-Key. 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: >- Cited payer policy lookup — GET /v1/policies and GET /v1/policies/changes. Medicare FFS returns NCDs/LCDs/MACs; commercial payers return that payer's documents only. Query payer, code, state, plan_type. name: policies - description: >- Payer-policy PDF parse and retrieve for Workspace / Payer Knowledge. Service-authenticated (X-Admin-Secret); chunks stored in Postgres. name: policy - description: >- Manufacturer 340B contract-pharmacy policy, fail-closed access, and the change feed. Different API from GET /v1/policies. name: 340B Policy - description: CRD-style prior authorization check, documentation, and vendors. name: prior-auth - description: Public payer directory (no API key on list/detail). name: payers-public - 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 - name: encounter - name: mcp - description: Health checks, service metadata, and Prometheus metrics. name: system paths: /v1/encounter/coverage: post: tags: - encounter summary: LCD/NCD medical-necessity coverage check description: >- Coverage-only medical-necessity check: match each procedure's diagnoses against the applicable Medicare local (LCD) and national (NCD) coverage determinations, localized by state → MAC jurisdiction. Does not run NCCI, MUE, timely filing, or payment. operationId: check_coverage_v1_encounter_coverage_post requestBody: content: application/json: schema: $ref: '#/components/schemas/EncounterCoverageRequest' required: true responses: '200': content: application/json: schema: $ref: '#/components/schemas/EncounterCoverageResponse' description: Successful Response '422': content: application/json: schema: $ref: '#/components/schemas/HTTPValidationError' description: Validation Error security: - APIKeyHeader: [] components: schemas: EncounterCoverageRequest: description: >- LCD/NCD medical-necessity coverage check for a claim's procedure lines. Coverage-only: this evaluates whether each procedure's diagnoses satisfy the applicable Medicare local (LCD) and national (NCD) coverage determinations. It does NOT run NCCI, MUE, timely filing, or payment. properties: claim_type: default: professional description: professional (per-line DX) or institutional (claim-level DX) title: Claim Type type: string date_of_service: anyOf: - type: string - type: 'null' description: Date of service (YYYY-MM-DD) title: Date Of Service dx: description: >- Claim-level ICD-10 diagnoses (837 loop 2300 HI). Applied to every line for institutional claims; used as a fallback for professional lines that carry no DX. The ABK-qualified (or first-listed) entry is the principal diagnosis. items: $ref: '#/components/schemas/EncounterDiagnosis' title: Dx type: array lines: description: Procedure lines to evaluate items: $ref: '#/components/schemas/EncounterCoverageLine' maxItems: 50 minItems: 1 title: Lines type: array payer: anyOf: - type: string - type: 'null' description: >- Reserved: payer overlay on top of the Medicare base layer. Not yet applied — non-Medicare values return the Medicare base with a warning. title: Payer state: anyOf: - type: string - type: 'null' description: >- 2-letter state → MAC jurisdiction for LCD localization (NCDs are national) title: State required: - lines title: EncounterCoverageRequest type: object EncounterCoverageResponse: description: Coverage-only medical-necessity assessment for a claim. properties: claim_type: title: Claim Type type: string contractor_id: anyOf: - type: string - type: 'null' description: Resolved MAC jurisdiction, e.g. JL title: Contractor Id coverage: items: $ref: '#/components/schemas/EncounterCoverageResult' title: Coverage type: array coverage_clean: description: >- True when no line has a coverage blocker (dx_not_on_lcd/dx_required/not_covered) title: Coverage Clean type: boolean date_of_service: anyOf: - type: string - type: 'null' title: Date Of Service state: anyOf: - type: string - type: 'null' title: State warnings: items: $ref: '#/components/schemas/EncounterWarning' title: Warnings type: array required: - claim_type - coverage_clean title: EncounterCoverageResponse type: object HTTPValidationError: properties: detail: items: $ref: '#/components/schemas/ValidationError' title: Detail type: array title: HTTPValidationError type: object EncounterDiagnosis: description: >- One diagnosis with its 837 loop 2300 HI qualifier (primary vs secondary). properties: code: description: ICD-10-CM diagnosis code title: Code type: string qualifier: default: ABF description: >- 837 HI qualifier: ABK=principal/primary, ABF=secondary, ABJ=admitting, APR=reason for visit, ABN=external cause. Accepts 'primary'/'secondary' aliases. title: Qualifier type: string required: - code title: EncounterDiagnosis type: object EncounterCoverageLine: description: >- One charge line: a procedure code with its linked diagnoses (professional). properties: code: description: CPT/HCPCS procedure code title: Code type: string dx: description: ICD-10 diagnoses linked to this line (professional claims) items: $ref: '#/components/schemas/EncounterDiagnosis' title: Dx type: array line_id: anyOf: - type: string - type: 'null' description: Caller line identifier, echoed back title: Line Id required: - code title: EncounterCoverageLine type: object EncounterCoverageResult: description: >- Coverage verdict for one line (professional) or one code (institutional). properties: code: title: Code type: string coverage_status: anyOf: - type: string - type: 'null' description: >- covered, dx_not_on_lcd, dx_required, not_covered, conditional, or null title: Coverage Status dx_required: default: false title: Dx Required type: boolean geo_scope: anyOf: - type: string - type: 'null' description: national (NCD) or mac_jurisdiction (LCD) title: Geo Scope lcd_id: anyOf: - type: string - type: 'null' title: Lcd Id line_id: anyOf: - type: string - type: 'null' title: Line Id matched_dx: items: type: string title: Matched Dx type: array ncd_id: anyOf: - type: string - type: 'null' title: Ncd Id policy_title: anyOf: - type: string - type: 'null' title: Policy Title primary_covered: default: false description: True when the principal diagnosis is on the covered list title: Primary Covered type: boolean primary_dx: anyOf: - type: string - type: 'null' description: The principal (ABK) diagnosis evaluated title: Primary Dx source: anyOf: - type: string - type: 'null' description: Which policy drove the verdict, e.g. medicare_lcd title: Source source_url: anyOf: - type: string - type: 'null' title: Source Url required: - code title: EncounterCoverageResult type: object EncounterWarning: description: A warning or advisory generated during encounter analysis. properties: code: anyOf: - type: string - type: 'null' title: Code message: title: Message type: string severity: description: info, warning, or critical title: Severity type: string required: - severity - message title: EncounterWarning 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 ````