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POST
Calculate expected payment

Authorizations

X-API-Key
string
header
required

Body

application/json

Calculate expected Medicare payment for a service at a facility.

ccn
string
required

6-digit Medicare Provider Number

Pattern: ^\d{6}$
Example:

"170001"

cpt
string
required

CPT procedure code

Pattern: ^[A-Za-z0-9]{5}$
Example:

"99213"

modifier
string | null

CPT modifier (e.g. 26, TC)

payer
string | null

Payer (defaults to Medicare; unused by fee-schedule math)

place_of_service
string | null

Place of service code

Example:

"11"

qpp
boolean
default:true

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

Response

Payment estimate with RVU/GPCI breakdown

Payment calculation result — same four blocks as GET /v1/codes/{code}/payment.

estimated_payment and components remain the physician (MPFS) view for existing clients. applicable_blocks plus physician / outpatient_facility / lab / dme are the calculator-parity composition.

ccn
string
required

Queried CCN

cpt
string
required

Queried CPT code

applicable_blocks
string[]
components
PaymentComponents · object

Physician MPFS breakdown: RVUs, GPCI values, conversion factor

conversion_factor
number | null
dme
DMEPaymentBlock · object | null

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

estimated_payment
number | null

Physician (MPFS) allowed amount in USD

facility
FacilityContextBlock · object | null

Facility context used to drive payment composition.

lab
LabPaymentBlock · object | null

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

methodology
string | null

Payment calculation methodology description

outpatient_facility
FacilityPaymentBlock · object | null

OPPS / outpatient hospital facility payment block.

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

physician
PhysicianPaymentBlock · object | null

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

policy_rules
PolicyRuleResponse · object[]
qpp
boolean
default:true
reliability
ReliabilityMetadata · object

User-visible reliability metadata for this payment composition.