Look up a medical code

Looks up medical codes (CPT, HCPCS, ICD-10, NDC) and returns coverage information.

Endpoint: GET /api/v1/codes/lookup

Availability: Live in production.

Authentication: API key in Authorization: Bearer <key> with the read scope.

Looks up medical codes (CPT, HCPCS, ICD-10, NDC) and returns coverage information. When exact match fails and fuzzy is enabled, returns suggestions based on code similarity and description matching.

Parameters

code (query, required): The medical code to look up
code_system (query): Hint for code system
jurisdiction (query): Filter policies by MAC jurisdiction code
include (query): Comma-separated list of additional data to include: rvu, policies, rates. Note that "rates" returns an archived 2022-08 UnitedHealthcare-only Transparency in Coverage snapshot, not current multi-payer pricing - see NegotiatedRateSummary.
fuzzy (query): Enable fuzzy matching on miss

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/codes/lookup?code=76942&code_system=CPT&jurisdiction=JM&include=rvu%2Cpolicies%2Crates&fuzzy=true" \
  -H "Authorization: Bearer $BACKWORK_API_KEY"

Example response (200)

{
  "success": true,
  "data": {
    "code": "76942",
    "code_system": "HCPCS",
    "found": true,
    "description": "string",
    "short_description": "string",
    "category": "string",
    "betos_code": "string",
    "poa_exempt": true,
    "is_active": true,
    "rvu": {
      "work_rvu": "string",
      "pe_rvu_nonfacility": "string",
      "pe_rvu_facility": "string",
      "mp_rvu": "string",
      "total_rvu_nonfacility": "string",
      "total_rvu_facility": "string",
      "non_facility_price": "string",
      "facility_price": "string",
      "conversion_factor": "string",
      "global_days": "string",
      "status_code": "string",
      "year": 0
    },
    "negotiated_rates": {
      "min_rate": "string",
      "max_rate": "string",
      "avg_rate": "string",
      "num_rates": 0,
      "payer": "string",
      "arrangement": "string",
      "source": "string",
      "payer_scope": "string",
      "as_of": "string",
      "billing_code_set": "string",
      "is_current": true
    },
    "policies": [
      {
        "policy_id": "string",
        "title": "string",
        "policy_type": "string",
        "disposition": "string",
        "source": "document",
        "grounding": "grounded",
        "jurisdiction": "string",
        "applicability_scope": "shared_markets",
        "applicability_markets": [
          "string"
        ],
        "applicability_evidence": {
          "document_sha256": "string",
          "market_index_listings": [],
          "document_statements": []
        },
        "applicability_note": "string",
        "effective_date": "string",
        "source_url": "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": []
        }
      }
    ],
    "suggestions": [
      {
        "code": "string",
        "code_system": "string",
        "description": "string",
        "score": 0,
        "match_type": "code"
      }
    ],
    "ndc_crosswalk": {
      "ndc": "string",
      "hcpcs_code": "string",
      "hcpcs_description": "string",
      "ndc_label": "string",
      "route": "string",
      "billing_units": "string",
      "conversion_factor": "string"
    }
  },
  "meta": {
    "request_id": "string",
    "timestamp": "2026-01-15T10:30:00Z",
    "includes": [
      "string"
    ],
    "fuzzy_enabled": true,
    "attributions": {
      "disclaimer": "string",
      "cpt": "string",
      "loinc": "string",
      "cms": "string",
      "payer_data": "string",
      "negotiated_rates": "string"
    }
  }
}

Authorization

bearerAuth

AuthorizationBearer <token>

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

code*string

The medical code to look up

Length1 <= length <= 20

code_system?string

Hint for code system

Value in

"CPT"
"HCPCS"
"ICD10CM"
"ICD10PCS"
"NDC"

jurisdiction?string

Filter policies by MAC jurisdiction code

Lengthlength <= 10

include?string

Comma-separated list of additional data to include: rvu, policies, rates. Note that "rates" returns an archived 2022-08 UnitedHealthcare-only Transparency in Coverage snapshot, not current multi-payer pricing - see NegotiatedRateSummary.

fuzzy?string

Enable fuzzy matching on miss

Default"true"

Value in

"true"
"false"

Response Body

`application/json`

curl -X GET "https://example.com/codes/lookup?code=76942"

{  "success": true,  "data": {    "code": "76942",    "code_system": "HCPCS",    "found": true,    "description": "string",    "short_description": "string",    "category": "string",    "betos_code": "string",    "poa_exempt": true,    "is_active": true,    "rvu": {      "work_rvu": "string",      "pe_rvu_nonfacility": "string",      "pe_rvu_facility": "string",      "mp_rvu": "string",      "total_rvu_nonfacility": "string",      "total_rvu_facility": "string",      "non_facility_price": "string",      "facility_price": "string",      "conversion_factor": "string",      "global_days": "string",      "status_code": "string",      "year": 0    },    "negotiated_rates": {      "min_rate": "string",      "max_rate": "string",      "avg_rate": "string",      "num_rates": 0,      "payer": "string",      "arrangement": "string",      "source": "string",      "payer_scope": "string",      "as_of": "string",      "billing_code_set": "string",      "is_current": true    },    "policies": [      {        "policy_id": "string",        "title": "string",        "policy_type": "string",        "disposition": "string",        "source": "document",        "grounding": "grounded",        "jurisdiction": "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",        "effective_date": "string",        "source_url": "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"            }          ]        }      }    ],    "suggestions": [      {        "code": "string",        "code_system": "string",        "description": "string",        "score": 0,        "match_type": "code"      }    ],    "ndc_crosswalk": {      "ndc": "string",      "hcpcs_code": "string",      "hcpcs_description": "string",      "ndc_label": "string",      "route": "string",      "billing_units": "string",      "conversion_factor": "string"    }  },  "meta": {    "request_id": "string",    "timestamp": "2019-08-24T14:15:22Z",    "includes": [      "string"    ],    "fuzzy_enabled": true,    "attributions": {      "disclaimer": "string",      "cpt": "string",      "loinc": "string",      "cms": "string",      "payer_data": "string",      "negotiated_rates": "string"    }  }}

Last updated on

Look up a medical code

Authorization

Query Parameters

Response Body

200application/json

400application/json

401application/json

402application/json

403application/json

429application/json

500application/json

`application/json`

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`application/json`

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