Search and list policies
Search and list coverage policies with filtering and cursor pagination.
Endpoint: GET /api/v1/policies
Availability: Live in production.
Authentication: API key in Authorization: Bearer <key> with the read scope.
Search and list coverage policies with filtering and cursor pagination. Supports keyword (PostgreSQL full-text) and semantic (vector) search modes; semantic results are a single ranked page. Pass format=csv or format=fhir (or _format=application/fhir+json) for CSV or FHIR R4 CoverageEligibilityResponse output.
Parameters
q(query): Search query (max 500 characters)mode(query): Search mode. With aq,semanticcounts as 4 requests.policy_type(query): Filter by policy typejurisdiction(query): Filter by MAC jurisdiction or publisher-indexed state (e.g., JE, OR); shared documents retain their scope labelline_of_business(query): Filter by a document-scoped line of business; shared-market documents never matchpayer(query): Filter by payer name (partial match). Supported in bothkeywordandsemanticsearch modes.icd10(query): Filter by ICD-10 code. Returns policies that cover this diagnosis code.status(query): Filter by policy statuscursor(query): Pagination cursor (base64url encoded) from the previous responselimit(query): Results per pageinclude(query): Additional data to include (comma-separated: summary, criteria, codes)
Code sources: Code entries in the response carry a source: document when the policy document lists the code, inferred_title_match when the code was attached because the policy title names the drug. See Code sources.
Example request
curl -X GET "https://backworkhealth.com/api/v1/policies?q=ultrasound+guidance&mode=keyword&policy_type=LCD&icd10=E11.9&status=active&include=summary%2Ccriteria%2Ccodes" \
-H "Authorization: Bearer $BACKWORK_API_KEY"Example response (200)
{
"success": true,
"data": [
{
"policy_id": "string",
"title": "string",
"policy_type": "string",
"jurisdiction": "string",
"effective_date": "2026-01-15",
"retire_date": "2026-01-15",
"status": "string",
"source_url": "string",
"payer": "string",
"payer_slug": "molina-healthcare",
"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": [
{}
]
},
"source_shape": "criteria_backed",
"source_shape_reason": "string",
"summary": "string",
"codes": [
{
"code": "string",
"code_system": "string",
"disposition": "string",
"source": "document",
"grounding": "grounded"
}
],
"code_count": 0,
"criteria": [
{
"section": "string",
"text": "string",
"tags": []
}
],
"relevance_score": 0
}
],
"meta": {
"request_id": "string",
"timestamp": "2026-01-15T10:30:00Z",
"pagination": {
"cursor": "string",
"has_more": true,
"limit": 0
},
"search": {
"query": "string",
"mode": "keyword",
"results": 0,
"fallback": "semantic_scope_not_indexed"
},
"filters": {
"policy_type": "string",
"jurisdiction": "string",
"line_of_business": "string",
"payer": "string",
"icd10": "string",
"status": "active"
},
"attributions": {
"disclaimer": "string",
"cpt": "string",
"loinc": "string",
"cms": "string",
"payer_data": "string",
"negotiated_rates": "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
Query Parameters
Search query (max 500 characters)
length <= 500Search mode. With a q, semantic counts as 4 requests.
"keyword"Value in
- "keyword"
- "semantic"
Filter by policy type
Value in
- "LCD"
- "Article"
- "NCD"
- "PayerPolicy"
- "Medical Policy"
- "Drug Policy"
Filter by MAC jurisdiction or publisher-indexed state (e.g., JE, OR); shared documents retain their scope label
length <= 10Filter by a document-scoped line of business; shared-market documents never match
length <= 50Filter by payer name (partial match). Supported in both keyword and semantic search modes.
length <= 50Filter by ICD-10 code. Returns policies that cover this diagnosis code.
length <= 10Filter by policy status
"active"Value in
- "active"
- "retired"
- "all"
Pagination cursor (base64url encoded) from the previous response
Results per page
1 <= value <= 10050Additional data to include (comma-separated: summary, criteria, codes)
Response Body
application/json
application/json
application/json
application/json
application/json
application/json
application/json
curl -X GET "https://example.com/policies"{ "success": true, "data": [ { "policy_id": "string", "title": "string", "policy_type": "string", "jurisdiction": "string", "effective_date": "2019-08-24", "retire_date": "2019-08-24", "status": "string", "source_url": "string", "payer": "string", "payer_slug": "molina-healthcare", "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" } ] }, "source_shape": "criteria_backed", "source_shape_reason": "string", "summary": "string", "codes": [ { "code": "string", "code_system": "string", "disposition": "string", "source": "document", "grounding": "grounded" } ], "code_count": 0, "criteria": [ { "section": "string", "text": "string", "tags": [ "string" ] } ], "relevance_score": 0 } ], "meta": { "request_id": "string", "timestamp": "2019-08-24T14:15:22Z", "pagination": { "cursor": "string", "has_more": true, "limit": 0 }, "search": { "query": "string", "mode": "keyword", "results": 0, "fallback": "semantic_scope_not_indexed" }, "filters": { "policy_type": "string", "jurisdiction": "string", "line_of_business": "string", "payer": "string", "icd10": "string", "status": "active" }, "attributions": { "disclaimer": "string", "cpt": "string", "loinc": "string", "cms": "string", "payer_data": "string", "negotiated_rates": "string" } }}Last updated on