Skip to main content
GET
Medicaid PTP edit — code pair

Authorizations

X-API-Key
string
header
required

Query Parameters

col1_proc_cd
string
required

Column 1 (comprehensive) procedure code; may carry modifiers, e.g. 11042-59

col2_proc_cd
string
required

Column 2 (component) procedure code; may carry modifiers, e.g. 97597-XS

claim_type
enum<string> | null

prac (practitioner), hosp (outpatient hospital), or dme

Available options:
prac,
hosp,
dme
date_of_service
string<date> | null

Date of service (YYYY-MM-DD); selects the edit effective on that date.

state
string | null

Two-letter US state (KS). Stamps which Medicaid program is applying the CMS Medicaid NCCI floor.

payer
string | null

Payer slug (masshealth, medi_cal). Optional label; this path is always the Medicaid file.

Response

Successful Response

Medicaid PTP bundling edit for a code pair.

col1_proc_cd
string
required

Column 1 (comprehensive) code

col2_proc_cd
string
required

Column 2 (component) code

bypass_modifier
string | null

The PTP-associated modifier that bypasses the edit (e.g. 25, 59, XU)

col1_modifiers
string[]

Modifiers sent on the column 1 code

col2_modifiers
string[]

Modifiers sent on the column 2 code

date_of_service
string | null
edit_delete_dt
string | null

Deletion date (empty if active)

edit_effective_dt
string | null

When this PTP edit took effect

edit_scope
string
default:cms_medicaid_national

cms_medicaid_national = CMS Medicaid NCCI floor the state must adopt

loaded_at
string<date-time> | null

When rcintel-data curated this row

modifier
string | null

Modifier indicator: 0=NOT ALLOWED, 1=ALLOWED, 9=NOT APPLICABLE

modifier_allowed
boolean | null

True when modifier is 1 or 9

on
enum<string> | null

Which code of the edit carried bypass_modifier: column_one or column_two

Available options:
column_one,
column_two
payer
string | null

Payer slug that selected this file

program
string
default:medicaid
Allowed value: "medicaid"
ptp_edit_rationale
string | null

CMS edit rationale

ptp_type
string | null

PTP table: prac, hosp, or dme

state
string | null

Two-letter US state (e.g. KS)

state_overlay
string | null

not_ingested when extra state SMA / Medi-Cal add-on files are not merged

status
enum<string> | null

conflict | allowed_with_modifier | not_applicable. allowed_with_modifier = indicator 1 and a PTP-associated modifier on either code. Null when the pair has no edit.

Available options:
conflict,
allowed_with_modifier,
not_applicable