Evaluate coverage criteria
Evaluate an active policy's structured coverage criteria (logic AST) against rule-level parameters.
Endpoint: POST /api/v1/coverage/evaluate
Availability: Live in production.
Authentication: API key in Authorization: Bearer <key> with the read scope.
Evaluate an active policy's structured coverage criteria (logic AST) against rule-level parameters. Returns whether the criteria are met, a confidence score, and detailed reasons. Coverage requires every evaluated criteria block to pass. Patient identifiers are rejected with PHI_NOT_ALLOWED.
Parameters
policy_id(body, required): The policy identifierparameters(body, required): Rule-level, non-identifying parameters to evaluate against the policy's criteria
Example request
curl -X POST "https://backworkhealth.com/api/v1/coverage/evaluate" \
-H "Authorization: Bearer $BACKWORK_API_KEY" \
-H "Content-Type: application/json" \
-d '{
"policy_id": "L33831",
"parameters": {}
}'Example response (200)
{
"success": true,
"data": {
"covered": true,
"confidence": 0.85,
"requires_manual_review": true,
"reasons": [
"string"
],
"matched_criteria": [
"string"
],
"unmatched_criteria": [
"string"
],
"skipped_criteria": [
"string"
],
"blocks_evaluated": 0,
"blocks_without_ast": 0,
"policy": {
"policy_id": "string",
"title": "string",
"policy_type": "string",
"applicability_scope": "shared_markets",
"applicability_markets": [
"string"
],
"applicability_evidence": {
"document_sha256": "string",
"market_index_listings": [
{}
],
"document_statements": [
{}
]
},
"applicability_note": "string",
"public_url": "https://backworkhealth.com/policy/L33831",
"source_check": {
"source_url": "https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33831",
"last_fetched_at": "2026-01-15T10:30:00Z",
"content_sha256": "9f86d081884c7d659a2feaa0c55ad015a3bf4f1b2b0b822cd15d6c15b0f00a08",
"source_accuracy": [
{}
]
}
}
},
"meta": {
"request_id": "string",
"timestamp": "2026-01-15T10:30:00Z",
"attributions": {
"disclaimer": "string",
"cpt": "string",
"loinc": "string",
"cms": "string",
"payer_data": "string",
"negotiated_rates": "string"
},
"disclaimer": "string"
}
}Authorization
bearerAuth API key in format: bwk_live_xxxxx. Keys issued before the rename (vrt_live_) remain valid. bwk_test_ keys work only on the sandbox.
In: header
Request Body
application/json
TypeScript Definitions
Use the request body type in TypeScript.
Response Body
application/json
application/json
application/json
application/json
application/json
application/json
application/json
application/json
curl -X POST "https://example.com/coverage/evaluate" \ -H "Content-Type: application/json" \ -d '{ "policy_id": "L33831", "parameters": {} }'{ "success": true, "data": { "covered": true, "confidence": 0.85, "requires_manual_review": true, "reasons": [ "string" ], "matched_criteria": [ "string" ], "unmatched_criteria": [ "string" ], "skipped_criteria": [ "string" ], "blocks_evaluated": 0, "blocks_without_ast": 0, "policy": { "policy_id": "string", "title": "string", "policy_type": "string", "applicability_scope": "shared_markets", "applicability_markets": [ "string" ], "applicability_evidence": { "document_sha256": "string", "market_index_listings": [ { "market": "string", "index_url": "string" } ], "document_statements": [ { "kind": "non_medicare_disclaimer", "quote": "string", "page": 1 } ] }, "applicability_note": "string", "public_url": "https://backworkhealth.com/policy/L33831", "source_check": { "source_url": "https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33831", "last_fetched_at": "2019-08-24T14:15:22Z", "content_sha256": "9f86d081884c7d659a2feaa0c55ad015a3bf4f1b2b0b822cd15d6c15b0f00a08", "source_accuracy": [ { "field": "overall", "sampled_at": "2019-08-24T14:15:22Z", "sample_size": 120, "accuracy": 0.9667, "ci_low": 0.917, "ci_high": 0.987, "method": "manual_review_v1" } ] } } }, "meta": { "request_id": "string", "timestamp": "2019-08-24T14:15:22Z", "attributions": { "disclaimer": "string", "cpt": "string", "loinc": "string", "cms": "string", "payer_data": "string", "negotiated_rates": "string" }, "disclaimer": "string" }}Last updated on