Coverage Data API¶

Complete API reference for querying CMS Medicare Coverage data including NCDs, LCDs, and Articles.

Overview¶

The Coverage Data API provides access to Medicare Coverage policy documents:

• NCDs - National Coverage Determinations (CMS-wide policies)
• LCDs - Local Coverage Determinations (regional MAC policies)
• Articles - Billing & Coding guidance documents

Base Path: /api/v1/coverage

Authentication: Required for all endpoints (Bearer token or API Key)

NCD Endpoints¶

Search NCDs¶

Search National Coverage Determinations with filtering and pagination.

Endpoint: GET /coverage/ncd/search

Query Parameters:

Response:

{
  "items": [
    {
      "ncd_id": 250,
      "ncd_version": 2,
      "ncd_manual_section": "20.9.1",
      "ncd_manual_section_title": "Ambulance Services",
      "ncd_effective_date": "2005-01-01",
      "publication_code": 1
    }
  ],
  "total": 450
}

Example Request:

curl -H "Authorization: Bearer YOUR_TOKEN" \
  "https://api.example.com/api/v1/coverage/ncd/search?keyword=ambulance"

Get NCD Document¶

Retrieve the HTML document for a specific NCD.

Endpoint: GET /coverage/ncd/doc/{id}/{version}/{section}

Path Parameters:

Response: HTML content of the NCD document

Example Request:

curl -H "Authorization: Bearer YOUR_TOKEN" \
  "https://api.example.com/api/v1/coverage/ncd/doc/250/2/20-9-1"

LCD Endpoints¶

Search LCDs¶

Search Local Coverage Determinations with filtering and pagination.

Endpoint: GET /coverage/lcd/search

Query Parameters:

Response:

{
  "items": [
    {
      "lcd_id": 35014,
      "lcd_version": 3,
      "display_id": "L35014",
      "title": "Wheelchair Seating",
      "status": "Current",
      "orig_det_eff_date": "2017-01-01",
      "rev_eff_date": "2024-01-15",
      "last_updated": "2024-01-10T12:00:00Z"
    }
  ],
  "total": 1250
}

Example Requests:

# Search by keyword
curl -H "Authorization: Bearer YOUR_TOKEN" \
  "https://api.example.com/api/v1/coverage/lcd/search?keyword=wheelchair"

# Filter by status
curl -H "Authorization: Bearer YOUR_TOKEN" \
  "https://api.example.com/api/v1/coverage/lcd/search?status=Current&limit=100"

Get LCD Document¶

Retrieve the HTML document for a specific LCD.

Endpoint: GET /coverage/lcd/doc/{id}/{version}

Path Parameters:

Response: HTML content of the LCD document

Example Request:

curl -H "Authorization: Bearer YOUR_TOKEN" \
  "https://api.example.com/api/v1/coverage/lcd/doc/35014/3"

List LCD HCPCS Codes¶

Get HCPCS codes associated with an LCD.

Endpoint: GET /coverage/lcd/{id}/{version}/hcpcs

Response:

{
  "lcd_id": 35014,
  "lcd_version": 3,
  "codes": [
    {
      "hcpc_code_id": "E1161",
      "hcpc_code_version": 1,
      "short_description": "Man w/c access folding",
      "long_description": "Manual adult size wheelchair..."
    }
  ],
  "count": 45
}

Article Endpoints¶

Search Articles¶

Search Billing & Coding Articles with filtering and pagination.

Endpoint: GET /coverage/article/search

Query Parameters:

Response:

{
  "items": [
    {
      "article_id": 57704,
      "article_version": 2,
      "article_type": 1,
      "display_id": "A57704",
      "title": "Billing and Coding: Wheelchair Seating",
      "status": "Current",
      "article_eff_date": "2024-01-15",
      "last_updated": "2024-01-10T12:00:00Z"
    }
  ],
  "total": 3500
}

Get Article Document¶

Retrieve the HTML document for a specific Article.

Endpoint: GET /coverage/article/doc/{id}/{version}

Path Parameters:

Response: HTML content of the Article document

List Article ICD-10 Codes¶

Get ICD-10 diagnosis codes associated with an Article.

Endpoint: GET /coverage/article/{id}/{version}/icd10

Query Parameters:

Response:

{
  "article_id": 57704,
  "article_version": 2,
  "covered_codes": [
    {
      "icd10_code_id": "M54.5",
      "description": "Low back pain"
    }
  ],
  "noncovered_codes": [
    {
      "icd10_code_id": "Z00.00",
      "description": "General adult medical exam"
    }
  ]
}

Common Response Fields¶

LCD Status Values¶

Date Formats¶

• Dates returned as ISO 8601 strings: YYYY-MM-DD
• Timestamps include time: YYYY-MM-DDTHH:MM:SSZ

Error Handling¶

Error Response:

{
  "detail": "LCD document not found for id=99999, version=1"
}

Rate Limits¶

• Standard: 100 requests/minute per API key
• Document endpoints: Count as 1 request regardless of document size
• Search endpoints: Pagination recommended for large result sets

Related Resources¶

• Coverage Data Viewer Guide - UI documentation
• Authentication Guide - API token setup
• MUE Data API - Units of service edits