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Look up cited policy

Coding engines need cited payer policy, not a single Medicare blob. Use GET /v1/policies with an X-API-Key. This is the client-facing policy API. POST /v1/policy/parse is an admin ingest path, not a client lookup. Medicare Fee-For-Service is national for NCDs and MAC-scoped for LCDs. Massachusetts and New York are both MAC JK (NGS). The API returns that jurisdiction instead of inventing two documents.

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Query parameters

Each row includes geo_scope, geo_codes, mac_jurisdiction, document_version, policy_type (medical / payment / prior_auth / provider_manual), codes_covered, codes_not_covered, icd10, delegated_entity, and effective_until. Code arrays and ICD are empty until mart_policy_document has extracted them — we do not invent coverage lists.

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Change feed

GET /v1/policies/changes is pull-only (same idea as GET /v1/340b/changes). Filter with payer and since. There is no policy webhook.

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REST

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MCP

Tool name: lookup_policy

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Plan types

Medicare Advantage is not a second medicare_ffs payer. Use the commercial parent slug (uhc, humana, bcbs) with plan_type=medicare_advantage. 340B manufacturer contract-pharmacy rules are a different API: 340B. Prior auth determinations: Prior authorization.