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GET
Validate a code pair against Medicaid PTP edits

Authorizations

X-API-Key
string
header
required

Query Parameters

code1
string
required

First procedure code

code2
string
required

Second procedure code

claim_type
enum<string> | null

prac, hosp, or dme

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

Date of service (YYYY-MM-DD)

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

Result of Medicaid PTP bundling validation between two codes.

code1
string
required
code2
string
required
is_bundled
boolean
required

Whether the pair has a Medicaid PTP edit

additional_claim_types
NCCIValidateClaimTypeResult · object[] | null
bypass_modifier
string | null

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

claim_type
string | null

Claim type for this result (professional/institutional/dme)

code1_modifiers
string[]
code2_modifiers
string[]
col1_proc_cd
string | null
col2_proc_cd
string | null
edit_scope
string
default:cms_medicaid_national

cms_medicaid_national = CMS Medicaid NCCI floor the state must adopt

effective_date
string | null
modifier_allowed
boolean | null
modifier_indicator
string | null
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_rationale
string | null
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