Search coverage criteria

Search through coverage criteria blocks (indications, limitations, documentation requirements) across active policies.

Endpoint: GET /api/v1/coverage/criteria

Availability: Live in production.

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

Search through coverage criteria blocks (indications, limitations, documentation requirements) across active policies.

Parameters

q (query, required): Search query for criteria text (max 500 characters)
section (query): Filter by section type
policy_type (query): Filter by policy type
jurisdiction (query): Filter by MAC jurisdiction
cursor (query): Pagination cursor from the previous response
limit (query): Results per page

Example request

curl -X GET "https://backworkhealth.com/api/v1/coverage/criteria?q=diabetes&section=indications&policy_type=LCD" \
  -H "Authorization: Bearer $BACKWORK_API_KEY"

Example response (200)

{
  "success": true,
  "data": [
    {
      "criteria_id": "string",
      "policy_id": "string",
      "policy_title": "string",
      "policy_type": "string",
      "jurisdiction": "string",
      "effective_date": "2026-01-15",
      "section": "string",
      "text": "string",
      "tags": [
        "string"
      ],
      "requires_manual_review": true,
      "confidence_score": "string",
      "policy": {
        "policy_id": "string",
        "title": "string",
        "policy_type": "string",
        "jurisdiction": "string",
        "effective_date": "2026-01-15",
        "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": []
        }
      },
      "applicability_scope": "shared_markets",
      "applicability_markets": [
        "string"
      ],
      "applicability_evidence": {
        "document_sha256": "string",
        "market_index_listings": [
          {}
        ],
        "document_statements": [
          {}
        ]
      },
      "applicability_note": "string"
    }
  ],
  "meta": {
    "request_id": "string",
    "timestamp": "2026-01-15T10:30:00Z",
    "pagination": {
      "cursor": "string",
      "has_more": true,
      "limit": 0
    },
    "search": {
      "query": "string",
      "section": "indications"
    },
    "filters": {
      "policy_type": "LCD",
      "jurisdiction": "string"
    },
    "attributions": {
      "disclaimer": "string",
      "cpt": "string",
      "loinc": "string",
      "cms": "string",
      "payer_data": "string",
      "negotiated_rates": "string"
    },
    "disclaimer": "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

q*string

Search query for criteria text (max 500 characters)

Length1 <= length <= 500

section?string

Filter by section type

Value in

"indications"
"limitations"
"documentation"
"frequency"
"other"

policy_type?string

Filter by policy type

Value in

"LCD"
"Article"
"NCD"
"PayerPolicy"

jurisdiction?string

Filter by MAC jurisdiction

Lengthlength <= 10

cursor?string

Pagination cursor from the previous response

limit?number

Results per page

Range1 <= value <= 100

Default50

Response Body

`application/json`

curl -X GET "https://example.com/coverage/criteria?q=diabetes"

{  "success": true,  "data": [    {      "criteria_id": "string",      "policy_id": "string",      "policy_title": "string",      "policy_type": "string",      "jurisdiction": "string",      "effective_date": "2019-08-24",      "section": "string",      "text": "string",      "tags": [        "string"      ],      "requires_manual_review": true,      "confidence_score": "string",      "policy": {        "policy_id": "string",        "title": "string",        "policy_type": "string",        "jurisdiction": "string",        "effective_date": "2019-08-24",        "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"            }          ]        }      },      "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"    }  ],  "meta": {    "request_id": "string",    "timestamp": "2019-08-24T14:15:22Z",    "pagination": {      "cursor": "string",      "has_more": true,      "limit": 0    },    "search": {      "query": "string",      "section": "indications"    },    "filters": {      "policy_type": "LCD",      "jurisdiction": "string"    },    "attributions": {      "disclaimer": "string",      "cpt": "string",      "loinc": "string",      "cms": "string",      "payer_data": "string",      "negotiated_rates": "string"    },    "disclaimer": "string"  }}

Last updated on

Search coverage criteria

Authorization

Query Parameters

Response Body

200application/json

400application/json

401application/json

402application/json

403application/json

429application/json

500application/json

`application/json`

`application/json`

`application/json`

`application/json`

`application/json`

`application/json`

`application/json`