cpt

Validate Cpt Claim

Scrub a claim against the CMS edit tables — deterministic, no LLM, no chart text.

Runs eleven deterministic engines (code existence, HCPCS Level II existence/validity/ coverage, date-of-service billability, PFS payment status, add-on primaries, NCCI PTP bundling, MUE unit ceilings, global periods, modifier applicability, code-category appropriateness, same-day E/M) and returns findings plus suggested fixes and Medicare RVU pricing context.

Nothing is auto-corrected. suggested_fixes is a separate list, and each fix carries requires_documentation: fixes that merely restate the claim (drop an impossible modifier, cap units at an absolute ceiling) are safe to apply mechanically, while fixes that assert a clinical fact (append 59, append 25) are not, and must not be applied without the note in front of a human.

Read engines_skipped before trusting a clean result. An engine whose CMS table is absent, or whose loaded snapshot does not cover the date of service, records itself there and emits an INFO finding — a claim with no findings because nobody looked is not a clean claim.

Requires Pro or Enterprise tier.

post/api/v1/cpt/validate

Request

  • Base URL: https://api.accurecord.io (the document declares no server; this is the origin it was published from)
  • URL: https://api.accurecord.io/api/v1/cpt/validate
  • Auth: none declared

Headers

x-api-keystring nullable

Request body

practice_settingstring

'practitioner', 'hospital' or 'dme_supplier'. ⚠ These are SEPARATE NCCI rulebooks, not a refinement of one another — a pair may be bundled in one and absent in the other. The default is practitioner; a facility biller must set it. 'dme_supplier' applies CMS's DME MUE edition; no NCCI PTP edition exists for it and the response says so.

prior_proceduresobject[]

Procedures performed on EARLIER claims, as {code, date}, for post-operative window checks. Omitting them does not mean there was no surgery — the global-period engine reports that it could not run.

patient_ageinteger nullable
patient_sexstring nullable
versioninteger nullable

CPT CALENDAR year (not the ICD fiscal year). Defaults to the loaded set.

payer_type'medicare_ffs' | 'medicare_advantage' | 'medicaid' | 'commercial' nullable

Who pays. Optional. Known: Medicare's dispositions are enforced for medicare_ffs (PFS N/B and HCPCS coverage I/M/S become blocking errors); for medicare_advantage Medicare's coding and coverage are stated as warnings, because the plan's own billing instructions decide; for medicaid/commercial a Medicare status is stated but never generalised. Absent: the payer is unresolved: every Medicare disposition is a warning that says so, and a line whose code depends on the payer is flagged, not billed as sent.

payer_statestring nullable

Two-letter state of the Medicaid programme. Only with payer_type=medicaid.

diagnosesstring[] nullable

The claim's Box 21 diagnoses, ICD-10-CM, lettered A-L in this order. Optional. Codes are checked as billable for the fiscal year of the date of service. Pointers are CHART-LINKED ONLY: a line points at a diagnosis only where the chart explicitly ties that service to it (quoted verbatim), otherwise the line carries the review item 'dx pointer not documented' — never a default.

Response

Successful Response

object required

Changes

No recorded changes to this operation across all 1 revision of this API.