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  • Dataset id: cms_medicare_coverage
  • Jurisdiction: US · CMS
  • Date field: effective_date. The search’s top-level date_from and date_to filter on it.
  • Access: any API key.

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Filters

Send these under filters.cms_medicare_coverage in a search request. A filter not listed here, or a value of the wrong type, is a 400. The top-level date_from and date_to set date_from and date_to below, so give a date in one place only.
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string
Exact MCD document id. LCDs are ‘L’ + digits (‘L33252’), articles ‘A’ + digits (‘A52369’), NCDs a manual section (‘310.1’).
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string
Keyword match on document title (BM25 tokenized). Example: ‘Psychiatric Diagnostic Evaluation’.
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string
Exact document type. ‘ncd’ = nationwide policy, ‘lcd’ = regional MAC policy, ‘article’ = billing/coding companion carrying the code lists.Values: ncd, lcd, article.
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string
Exact article category; NULL on ncd/lcd rows. ‘billing_and_coding’ is the one carrying CPT/HCPCS and ICD-10 code lists.Values: billing_and_coding, response_to_comments, article, sad_exclusion, faq.
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string
Exact published section a row came from. ‘coverage_indications’ holds an LCD’s or NCD’s medical-necessity criteria; ‘article_text’ the body of a Local Coverage Article; ‘icd10_covered’ / ‘icd10_noncovered’ the diagnosis-code lists; ‘hcpcs_codes’ the procedure-code list.Values: coverage_indications, cms_coverage_policy, article_text, summary_of_evidence, analysis_of_evidence, associated_information, bibliography, revision_history, item_service_description, cross_references, other, hcpcs_codes, icd10_covered, icd10_noncovered, icd10_additional.
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string
Exact document status. ‘active’ is in force, ‘proposed’ is a draft out for comment (no effective date), ‘retired’ was withdrawn by CMS.Values: active, proposed, retired.
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string
Exact CPT/HCPCS code listed by the document. Example: ‘29877’, ‘J9035’. Matches any document whose code list contains it.
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string
Exact 2-letter USPS state or territory code the local policy applies in. Example: ‘CA’, ‘NY’, ‘PR’, ‘MP’. MAC sub-jurisdictions are normalized to their parent state, so ‘CA’ also matches a Northern-California-only policy. NCDs are nationwide and carry no state.
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string
Keyword match on the issuing Medicare Administrative Contractor (BM25 tokenized). Example: ‘Noridian’, ‘Palmetto GBA’.
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string
Keyword match on an NCD’s Medicare benefit category (BM25 tokenized). Example: ‘Ambulance Services’, ‘Prosthetic Devices’.
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string
Exact id of a document cross-referenced by this one. Example: ‘L33394’ to find the articles attached to that LCD.
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string (date)
Inclusive lower bound on effective date (YYYY-MM-DD).
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string (date)
Inclusive upper bound on effective date (YYYY-MM-DD).

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Fields

Each result from this dataset has these in fields: article_category, benefit_categories, document_id, document_type, effective_date, hcpcs_codes, id, keywords, last_updated, mac_contractors, original_effective_date, related_document_ids, retired_date, section, states, status, title, url, version