{ "openapi": "3.0.1", "info": { "title": "Medicare Tools: Fee Schedule & LCD Lookup", "description": "Medicare physician, clinical lab, and DMEPOS fee schedules by CPT/HCPCS and locality, with LCD coverage matches and office vs ASC vs hospital comparisons. Built on current CMS files, verified to the cent.", "version": "0.1", "x-build-id": "eQDWu2omZyLb14Wk9" }, "servers": [ { "url": "https://api.apify.com/v2" } ], "paths": { "/acts/iceni-data~medicare-fee-coverage-lookup/run-sync-get-dataset-items": { "post": { "operationId": "run-sync-get-dataset-items-iceni-data-medicare-fee-coverage-lookup", "x-openai-isConsequential": false, "summary": "Executes an Actor, waits for its completion, and returns Actor's dataset items in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK" } } } }, "/acts/iceni-data~medicare-fee-coverage-lookup/runs": { "post": { "operationId": "runs-sync-iceni-data-medicare-fee-coverage-lookup", "x-openai-isConsequential": false, "summary": "Executes an Actor and returns information about the initiated run in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK", "content": { "application/json": { "schema": { "$ref": "#/components/schemas/runsResponseSchema" } } } } } } }, "/acts/iceni-data~medicare-fee-coverage-lookup/run-sync": { "post": { "operationId": "run-sync-iceni-data-medicare-fee-coverage-lookup", "x-openai-isConsequential": false, "summary": "Executes an Actor, waits for completion, and returns the OUTPUT from Key-value store in response.", "tags": [ "Run Actor" ], "requestBody": { "required": true, "content": { "application/json": { "schema": { "$ref": "#/components/schemas/inputSchema" } } } }, "parameters": [ { "name": "token", "in": "query", "required": true, "schema": { "type": "string" }, "description": "Enter your Apify token here" } ], "responses": { "200": { "description": "OK" } } } } }, "components": { "schemas": { "inputSchema": { "type": "object", "required": [ "hcpcs_codes" ], "properties": { "mode": { "title": "Mode", "enum": [ "lookup", "site_of_service", "lcd_matrix" ], "type": "string", "description": "\"lookup\" (default) is a plain per-code lookup, dispatched by `schedule` below. \"site_of_service\" returns PFS office/facility payment alongside ASC and hospital-outpatient (OPPS) amounts for the same code/locality — `schedule` is ignored. \"lcd_matrix\" returns covered/not_covered/no_policy per MAC jurisdiction from the cached MCD LCD data — `schedule` is ignored.", "default": "lookup" }, "schedule": { "title": "Fee schedule", "enum": [ "pfs", "clfs", "dmepos" ], "type": "string", "description": "Only consulted when `mode` is \"lookup\". \"pfs\" prices `hcpcs_codes` against the Physician Fee Schedule (RVU-based, by locality — needs `localities`). \"clfs\" looks up `hcpcs_codes` against the Clinical Laboratory Fee Schedule's national payment rate instead — no locality involved, and accepts PLA codes (e.g. \"0011U\") as well as CPT lab codes. \"dmepos\" looks up `hcpcs_codes` against the DMEPOS fee schedule per state (needs `states`).", "default": "pfs" }, "hcpcs_codes": { "title": "HCPCS/CPT codes", "type": "array", "description": "HCPCS or CPT codes to price, e.g. \"99213\" (office visit) or \"96900\" (actinotherapy) for `schedule: \"pfs\"`; lab or PLA codes like \"80053\" or \"0011U\" for `schedule: \"clfs\"`; DME codes like \"E0607\" for `schedule: \"dmepos\"`.", "items": { "type": "string" } }, "localities": { "title": "Localities", "type": "array", "description": "Medicare locality codes in `STATE-LOCALITYNUMBER` form (e.g. \"CA-18\" for Los Angeles), or a bare two-letter state/territory code (e.g. \"CA\") to expand to every locality CMS defines within it. Required for `schedule: \"pfs\"` and `mode: \"site_of_service\"`; ignored otherwise.", "items": { "type": "string" } }, "site_of_service": { "title": "Site of service", "enum": [ "office", "facility" ], "type": "string", "description": "`schedule: \"pfs\"` lookups only: which practice-expense RVU to price. \"office\" uses the non-facility PE RVU, \"facility\" uses the facility PE RVU. To compare all sites (office/facility/ASC/hospital-outpatient) at once, use `mode: \"site_of_service\"` instead.", "default": "office" }, "apm_qualifying": { "title": "APM-qualifying (QP) conversion factor", "type": "boolean", "description": "Beginning 2026, CMS pays a higher PFS conversion factor to clinicians who are Qualifying Alternative Payment Model (APM) Participants (QPs) for the year. Set true to price with that differential conversion factor instead of the standard one. Applies to `schedule: \"pfs\"` lookups and `mode: \"site_of_service\"`.", "default": false }, "states": { "title": "States", "type": "array", "description": "Two-letter state codes to price against, e.g. \"CA\". `schedule: \"dmepos\"` only.", "items": { "type": "string" } }, "rural": { "title": "Rural rate", "type": "boolean", "description": "`schedule: \"dmepos\"` only: price at the rural rate instead of non-rural. Falls back to the non-rural rate for a code/state where CMS hasn't published a distinct rural rate (see README).", "default": false }, "force_refresh": { "title": "Maintenance mode: force refresh", "type": "boolean", "description": "Reload the PFS RVU, GPCI, NCCI MUE, CLFS, DMEPOS, ASC, OPPS, and MCD LCD/Article files from CMS and rebuild the cached lookup table even if the cache is under 30 days old.", "default": false } } }, "runsResponseSchema": { "type": "object", "properties": { "data": { "type": "object", "properties": { "id": { "type": "string" }, "actId": { "type": "string" }, "userId": { "type": "string" }, "startedAt": { "type": "string", "format": "date-time", "example": "2025-01-08T00:00:00.000Z" }, "finishedAt": { "type": "string", "format": "date-time", "example": "2025-01-08T00:00:00.000Z" }, "status": { "type": "string", "example": "READY" }, "meta": { "type": "object", "properties": { "origin": { "type": "string", "example": "API" }, "userAgent": { "type": "string" } } }, "stats": { "type": "object", "properties": { "inputBodyLen": { "type": "integer", "example": 2000 }, "rebootCount": { "type": "integer", "example": 0 }, "restartCount": { "type": "integer", "example": 0 }, "resurrectCount": { "type": "integer", "example": 0 }, "computeUnits": { "type": "integer", "example": 0 } } }, "options": { "type": "object", "properties": { "build": { "type": "string", "example": "latest" }, "timeoutSecs": { "type": "integer", "example": 300 }, "memoryMbytes": { "type": "integer", "example": 1024 }, "diskMbytes": { "type": "integer", "example": 2048 } } }, "buildId": { "type": "string" }, "defaultKeyValueStoreId": { "type": "string" }, "defaultDatasetId": { "type": "string" }, "defaultRequestQueueId": { "type": "string" }, "buildNumber": { "type": "string", "example": "1.0.0" }, "containerUrl": { "type": "string" }, "usage": { "type": "object", "properties": { "ACTOR_COMPUTE_UNITS": { "type": "integer", "example": 0 }, "DATASET_READS": { "type": "integer", "example": 0 }, "DATASET_WRITES": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_READS": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_WRITES": { "type": "integer", "example": 1 }, "KEY_VALUE_STORE_LISTS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_READS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_WRITES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_INTERNAL_GBYTES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_EXTERNAL_GBYTES": { "type": "integer", "example": 0 }, "PROXY_RESIDENTIAL_TRANSFER_GBYTES": { "type": "integer", "example": 0 }, "PROXY_SERPS": { "type": "integer", "example": 0 }, "PROXY_UNBLOCKER_UNITS": { "type": "integer", "example": 0 } } }, "usageTotalUsd": { "type": "number", "example": 0.00005 }, "usageUsd": { "type": "object", "properties": { "ACTOR_COMPUTE_UNITS": { "type": "integer", "example": 0 }, "DATASET_READS": { "type": "integer", "example": 0 }, "DATASET_WRITES": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_READS": { "type": "integer", "example": 0 }, "KEY_VALUE_STORE_WRITES": { "type": "number", "example": 0.00005 }, "KEY_VALUE_STORE_LISTS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_READS": { "type": "integer", "example": 0 }, "REQUEST_QUEUE_WRITES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_INTERNAL_GBYTES": { "type": "integer", "example": 0 }, "DATA_TRANSFER_EXTERNAL_GBYTES": { "type": "integer", "example": 0 }, "PROXY_RESIDENTIAL_TRANSFER_GBYTES": { "type": "integer", "example": 0 }, "PROXY_SERPS": { "type": "integer", "example": 0 }, "PROXY_UNBLOCKER_UNITS": { "type": "integer", "example": 0 } } } } } } } } } }