Fee Schedules API¶

Complete API reference for querying Medicare fee schedule data programmatically.

Overview¶

The Fee Schedules API provides read-only access to Medicare fee schedule pricing data across multiple schedule types. All endpoints require authentication and support flexible filtering, pagination, and temporal queries.

Base Path: /api/v1/fee-schedules

Authentication: Required for all endpoints (Bearer token)

Schedule Types¶

The following schedule types are available:

Endpoints¶

Search Fee Schedules¶

Search and filter fee schedule records with pagination.

Endpoint: GET /fee-schedules/search

Query Parameters:

Response:

{
  "data": [
    {
      "id": 123456,
      "code": "99213",
      "schedule_type": 0,
      "start_date": 20250101,
      "end_date": 20251231,
      "modifiers": null,
      "price_indicator": "9",
      "data": { /* schedule-specific fields */ },
      "created_at": "2025-01-01T00:00:00Z",
      "updated_at": "2025-01-01T00:00:00Z"
    }
  ],
  "count": 1523
}

Example Requests:

# Search for code 99213 (office visit)
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/search?code=99213"

# Get all PFS codes active on January 1, 2025
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/search?schedule_type=0&start_date_from=20250101&limit=100"

# Find Qualifyng APM Participant (QP) rates for codes starting with 99
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/search?code=99&price_indicator=1"

Use Cases:

• Code lookup: Search by code prefix to find specific procedures
• Date-based queries: Find pricing active on specific dates
• Modifier analysis: Compare base vs modified pricing
• Bulk export: Paginate through all records for data warehousing

Calculate PFS Rate¶

Calculate geographically-adjusted Physician Fee Schedule (PFS) rates in a single API call.

Endpoint: GET /fee-schedules/pfs/calculate

Query Parameters:

Response:

{
  "npi": "1234567890",
  "code": "99213",
  "code_description": "Office o/p est low 20 min",
  "service_date": 20260315,
  "rates": {
    "facility_rate": 57.47,
    "non_facility_rate": 95.18,
    "components": {
      "rvu_work": 1.30,
      "rvu_mp": 0.09,
      "full_fac_pe": 0.33,
      "full_nfac_pe": 1.46,
      "conv_fact": 33.4009,
      "gpci_work": 1.035,
      "gpci_pe": 1.094,
      "gpci_mp": 0.723
    }
  },
  "locality_info": {
    "locality": "0110102",
    "loc_description": "Manhattan, NY",
    "mac": "05102",
    "mac_description": "National Government Services",
    "year": 2026,
    "zip_code": "10001"
  },
  "fee_schedule_id": 163503
}

Example Request:

curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/pfs/calculate?npi=1234567890&code=99213&date=20260315"

Use Cases:

• EHR Integration: Build patient estimators by surfacing expected reimbursement.
• Contract Modeling: Estimate allowable amounts interactively.
• Provider Transparency: Give providers a clear geographic breakdown of their rates.

Get Schedule Types¶

Retrieve list of available schedule types.

Endpoint: GET /fee-schedules/schedule-types

Response:

[
  { "id": 0, "name": "Physician Fee Schedule" },
  { "id": 1, "name": "Clinical Lab Fee Schedule" },
  { "id": 3, "name": "Durable Medical Equipment Fee Schedule" },
  { "id": 4, "name": "Ambulance Fee Schedule" },
  { "id": 5, "name": "ASP Pricing Files" }
]

Example Request:

curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/schedule-types"

Use Cases:

• Dynamic UI generation: Populate dropdowns with available schedule types
• Validation: Verify schedule type IDs before making queries

Get Fee Schedule Statistics¶

Get aggregate statistics about the fee schedule database.

Endpoint: GET /fee-schedules/stats

Response:

{
  "total_records": 2847563,
  "by_schedule_type": {
    "Physician Fee Schedule": 1250000,
    "Clinical Lab Fee Schedule": 450000,
    "Ambulatory Surgical Center Fee Schedule": 320000,
    "Durable Medical Equipment Fee Schedule": 280000,
    "Ambulance Fee Schedule": 125000,
    "ASP Pricing Files": 422563
  },
  "date_range": {
    "earliest": 20150101,
    "latest": 20251231
  },
  "unique_codes": 18453
}

Example Request:

curl -H "Authorization: sk_live_abc123..." \
  "https://api.example.com/api/v1/fee-schedules/stats"

Use Cases:

• Data coverage validation: Verify available date ranges
• System monitoring: Track database growth over time
• Analytics: Understand distribution across schedule types

Get Code Timeline¶

Retrieve all temporal versions of a specific code.

Endpoint: GET /fee-schedules/code/{code}/timeline

Path Parameters:

Query Parameters:

Response:

[
  {
    "id": 123456,
    "start_date": 20250101,
    "end_date": 20251231,
    "label": "20250101 - 20251231",
    "is_active": true
  },
  {
    "id": 123455,
    "start_date": 20240101,
    "end_date": 20241231,
    "label": "20240101 - 20241231",
    "is_active": false
  }
]

Example Requests:

# Get timeline for code 99213
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/code/99213/timeline"

# Get timeline for code with modifier TC
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/code/71010/timeline?modifier=TC"

# Get timeline for Clinical Lab code
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/code/80053/timeline?schedule_type=1"

Use Cases:

• Price history analysis: Track how pricing changed over time
• Date range selection: Populate UI with available date ranges
• Trend identification: Identify pricing patterns and adjustments

Get Code Modifiers¶

Retrieve all modifier combinations available for a specific code.

Endpoint: GET /fee-schedules/code/{code}/modifiers

Path Parameters:

Query Parameters:

Response:

[
  {
    "modifiers": null,
    "display": "Base",
    "record_count": 3,
    "latest_start_date": 20250101
  },
  {
    "modifiers": ["TC"],
    "display": "TC",
    "record_count": 3,
    "latest_start_date": 20250101
  },
  {
    "modifiers": ["26"],
    "display": "26",
    "record_count": 3,
    "latest_start_date": 20250101
  }
]

Example Requests:

# Get all modifiers for code 71010
curl -H "Authorization: API_KEY..." \
  "https://api.example.com/api/v1/fee-schedules/code/71010/modifiers"

Use Cases:

• Related code discovery: Find all variations of a base code
• Modifier validation: Verify which modifiers are billable
• UI navigation: Show available modifier options to users

Get Single Fee Schedule Record¶

Retrieve a specific fee schedule record by ID.

Endpoint: GET /fee-schedules/{record_id}

Path Parameters:

Response:

{
  "id": 123456,
  "code": "99213",
  "schedule_type": 0,
  "start_date": 20250101,
  "end_date": 20251231,
  "modifiers": null,
  "price_indicator": "9",
  "data": { /* schedule-specific fields */ },
  "created_at": "2025-01-01T00:00:00Z",
  "updated_at": "2025-01-01T00:00:00Z"
}

Example Request:

curl -H "Authorization: sk_live_abc123..." \
  "https://api.example.com/api/v1/fee-schedules/123456"

Use Cases:

• Direct record lookup: Retrieve specific record by ID
• Bookmark/share: Enable deep linking to specific records

Common Patterns¶

Date Format¶

All dates use YYYYMMDD integer format: - January 1, 2025 = 20250101 - December 31, 2025 = 20251231

Modifier Handling¶

• Base pricing: modifiers = null or has_modifiers = false
• Modified pricing: modifiers = ["TC"] or modifier = "TC"
• Multiple modifiers: modifiers = ["TC", "26"] (array of strings)

Pagination Strategy¶

For large result sets:

# Example: Export all PFS records
skip = 0
limit = 500
all_records = []

while True:
    response = requests.get(
        "https://api.example.com/api/v1/fee-schedules/search",
        params={
            "schedule_type": 0,
            "skip": skip,
            "limit": limit
        },
        headers={"Authorization": f"{api_key}"}
    )
    data = response.json()

    all_records.extend(data["data"])

    if skip + limit >= data["count"]:
        break

    skip += limit

Error Handling¶

Rate Limiting¶

API requests are subject to rate limiting: - Limit: 100 requests per minute per user - Headers: Check X-RateLimit-Remaining and X-RateLimit-Reset response headers

Support¶

For API support, authentication issues, or bulk data access: - Examples: See API Examples - Support Contact support@bedrockbilling.com

Related Resources¶

• Fee Schedules Viewer Guide - UI documentation
• Authentication Guide - API token setup
• Data Models Reference - Complete field definitions