Skip to main content
GET
Policies that reference an ICD-10-CM diagnosis

Authorizations

X-API-Key
string
header
required

Query Parameters

dx
string
required

ICD-10-CM code, dotted or not (E11.65 or E1165)

payer
string | null

Payer slug; default Medicare FFS

cpt
string | null

Optional CPT/HCPCS: limits to policies pairing it with dx and adds a coverage verdict

state
string | null

US state → Medicare MAC for LCD localization

facility_type
string | null

Optional facility type filter (fqhc, rhc, ...)

include_descendants
boolean
default:true

For a category (E11), also match policies listing its child codes

limit
integer
default:100

Maximum number of records to return.

Required range: 1 <= x <= 500

Response

Successful Response

count
integer
required
dx
string
required
dx_normalized
string
required
payer
string
required
cpt
string | null
dx_description
string | null

Null until the ICD-10-CM table is loaded

facility_type
string | null
mac
Mac · object | null
policies
DxPolicyRow · object[]
processing
DxProcessing · object | null

Medical-necessity verdict for the requested CPT + DX pair.

state
string | null
warnings
string[]