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GET
MUE limits — Practitioner Services

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

date_of_service
string<date> | null

Date of service (YYYY-MM-DD); selects the NCCI version active on that date. Defaults to today.

include_summary
boolean
default:false

Include AI-generated clinical summary

state
string | null

Two-letter US state (KS). Claim geography; Medicare NCCI itself is national.

payer
string | null

Payer slug. medicaid / masshealth / medi_cal selects the CMS Medicaid NCCI file on /validate.

Response

Successful Response

MUE (Medically Unlikely Edit) for a single code + setting.

proc_cd
string
required

HCPCS/CPT procedure code

ai_summary
string | null

AI-generated plain-English summary

date_of_service
string | null

Service date used for lookup

edit_scope
string | null
default:cms_medicare_national

CMS Medicare NCCI is not state-split

mue_adj_ind
string | null

MAI label: '1 Line Edit', '2 Date of Service Edit: Policy', '3 Date of Service Edit: Clinical'

mue_rationale
string | null

CMS rationale (e.g. Clinical: Data)

mue_type
string | null

MUE table: practitioner, hosp-op, or dme

mue_value
integer | null

Maximum units of service per encounter

payer
string | null
program
string | null
default:medicare

medicare (CMS national NCCI)

sentinel
SentinelBlock · object | null

SENTINEL trust verdict for the AI summary. Present whenever include_summary=true. Use sentinel.escalation_required to decide whether to show the summary unattended or route it to a human reviewer.

state
string | null

Two-letter US state (claim geography; file is national)

state_overlay
string | null
version_effective_dt
string | null

Effective date of the CMS NCCI version

version_posted_dt
string | null

Date the CMS version was posted