Look up a medical code

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.

Authorization

bearerAuth

AuthorizationBearer <token>

API keys are prefixed with bwk_live_ for production or bwk_test_ for testing. Example: bwk_live_abc123xyz

Keys issued before the current format carry the vrt_live_/vrt_test_ prefix. Both prefixes are accepted while integrations rotate.

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://backworkhealth.com/api/v1/codes/lookup?code=76942&jurisdiction=JM&include=rvu%2Cpolicies%2Crates"

{
  "success": true,
  "data": {
    "code": "76942",
    "code_system": "HCPCS",
    "found": true,
    "description": "Ultrasonic guidance for needle placement",
    "short_description": "string",
    "category": "string",
    "betos_code": "string",
    "poa_exempt": true,
    "is_active": true,
    "rvu": {
      "work_rvu": "0.67",
      "pe_rvu_nonfacility": "string",
      "pe_rvu_facility": "string",
      "mp_rvu": "string",
      "total_rvu_nonfacility": "string",
      "total_rvu_facility": "string",
      "non_facility_price": "85.23",
      "facility_price": "42.11",
      "conversion_factor": "33.4009",
      "global_days": "000",
      "status_code": "A",
      "year": 2025
    },
    "policies": [
      {
        "policy_id": "L33831",
        "title": "Ultrasound Guidance for Needle Placement",
        "policy_type": "LCD",
        "disposition": "covered",
        "jurisdiction": "JM",
        "effective_date": "2024-01-01"
      }
    ],
    "suggestions": [
      {
        "code": "76942",
        "code_system": "HCPCS",
        "description": "string",
        "score": 0.95,
        "match_type": "code"
      }
    ],
    "negotiated_rates": {
      "min_rate": "1.30",
      "max_rate": "978.71",
      "avg_rate": "193.32",
      "num_rates": 28243,
      "payer": "United HealthCare Services, Inc.",
      "arrangement": "ffs",
      "source": "dolthub/transparency-in-coverage",
      "payer_scope": "UnitedHealthcare only",
      "as_of": "2022-08",
      "billing_code_set": "CPT 2020",
      "is_current": false
    },
    "ndc_crosswalk": {
      "ndc": "00023-1145-01",
      "hcpcs_code": "J0585",
      "hcpcs_description": "string",
      "ndc_label": "Botox",
      "route": "Injection",
      "billing_units": "string",
      "conversion_factor": "string"
    }
  },
  "meta": {
    "request_id": "string",
    "includes": [
      "string"
    ],
    "fuzzy_enabled": true
  }
}

{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}

{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}

{
  "success": false,
  "error": {
    "code": "VALIDATION_ERROR",
    "message": "Invalid query parameters",
    "hint": "Check the 'code' parameter format",
    "details": {}
  },
  "meta": {
    "request_id": "req_abc123"
  }
}

Last updated on

Look up a medical code

Authorization

Query Parameters

Response Body

200application/json

400application/json

401application/json

429application/json

`application/json`

`application/json`

`application/json`

`application/json`