# Introduction URL: https://backworkhealth.com/docs The Backwork API turns Medicare and commercial coverage policies into structured, source-backed JSON Backwork turns Medicare and commercial payer coverage policies into structured data: which policies apply to a code, whether prior authorization is required, the coverage criteria, and what changed. You call it over a REST API or from an AI client through MCP. **Production availability of the endpoints on this page** | Operation | Endpoint | Production | | ---------------------------------------------------------------------- | ------------------------------- | ---------- | | [`lookupCode`](/docs/api/lookupCode) | `GET /api/v1/codes/lookup` | Live | | [`checkPriorAuth`](/docs/api/checkPriorAuth) | `POST /api/v1/prior-auth/check` | Live | | [`comparePolicies`](/docs/api/comparePolicies) | `POST /api/v1/policies/compare` | Live | | [`getPolicyChanges`](/docs/api/getPolicyChanges) | `GET /api/v1/policies/changes` | Live | | [`batchLookupCodes`](/docs/api/batchLookupCodes) | `POST /api/v1/codes/batch` | Live | | [`searchDrugFormularyEvidence`](/docs/api/searchDrugFormularyEvidence) | `GET /api/v1/drugs/formulary` | Live | | [`listPolicies`](/docs/api/listPolicies) | `GET /api/v1/policies` | Live | ## Get started [#get-started] Sign up free at [backworkhealth.com](https://backworkhealth.com/sign-up). Your organization gets 100 free starter credits, and you create a live key yourself in [API usage and keys](https://backworkhealth.com/api-usage). When you need more, buy a Credits pack ($20 for 1,000 requests) or start a monthly pack on the same page. ## What Backwork does [#what-backwork-does] Coverage policies are spread across CMS documents, Medicare contractor publications, and commercial payer portals, mostly as PDFs. Backwork extracts coverage criteria, prior-authorization requirements, and code lists from Medicare LCDs, Articles, and NCDs and from commercial payer policies, and serves them as JSON with a link to each source document. Every code linked to a policy says where the link came from: the policy document lists it (`document`), or Backwork inferred it from the policy title (`inferred_title_match`). See [Code sources](/docs/code-sources). ## Your first request [#your-first-request] ```bash curl "https://backworkhealth.com/api/v1/codes/lookup?code=99213&include=policies" \ -H "Authorization: Bearer $BACKWORK_API_KEY" ``` The [Quickstart](/docs/quickstart) shows the response. ## Common tasks [#common-tasks] ### Check whether a procedure needs prior authorization [#check-whether-a-procedure-needs-prior-authorization] ```bash curl -X POST "https://backworkhealth.com/api/v1/prior-auth/check" \ -H "Authorization: Bearer $BACKWORK_API_KEY" \ -H "Content-Type: application/json" \ -d '{"procedure_codes": ["27447"], "state": "TX"}' ``` The response lists the matching policies, the coverage status, and the documentation the policies ask for. See [`checkPriorAuth`](/docs/api/checkPriorAuth). ### Compare coverage across MAC jurisdictions [#compare-coverage-across-mac-jurisdictions] Medicare coverage varies by MAC jurisdiction: a procedure covered in one can have different criteria in another. ```bash curl -X POST "https://backworkhealth.com/api/v1/policies/compare" \ -H "Authorization: Bearer $BACKWORK_API_KEY" \ -H "Content-Type: application/json" \ -d '{"procedure_codes": ["76942"], "jurisdictions": ["J5", "J6", "JM"]}' ``` ### Review recent policy changes [#review-recent-policy-changes] ```bash curl "https://backworkhealth.com/api/v1/policies/changes?since=2026-09-01T00:00:00Z&limit=20" \ -H "Authorization: Bearer $BACKWORK_API_KEY" ``` ### Look up many codes at once [#look-up-many-codes-at-once] ```bash curl -X POST "https://backworkhealth.com/api/v1/codes/batch" \ -H "Authorization: Bearer $BACKWORK_API_KEY" \ -H "Content-Type: application/json" \ -d '{"codes": ["99213", "E11.9", "27447"], "include": "policies"}' ``` ### Search commercial formulary evidence [#search-commercial-formulary-evidence] Search pharmacy-benefit evidence from CVS Caremark, Express Scripts, and UnitedHealthcare / Optum Rx: ```bash curl "https://backworkhealth.com/api/v1/drugs/formulary?q=metformin&payer=all&limit=5" \ -H "Authorization: Bearer $BACKWORK_API_KEY" ``` Each record names its source and includes tier, coverage status, utilization management requirements, alternatives, and the source URL. ### Export as CSV or FHIR [#export-as-csv-or-fhir] Policy endpoints return JSON by default, CSV with `format=csv`, and FHIR R4 `CoverageEligibilityResponse` resources with `format=fhir`: ```bash curl "https://backworkhealth.com/api/v1/policies?icd10=E11.9&format=csv" \ -H "Authorization: Bearer $BACKWORK_API_KEY" ``` ## Limits [#limits] * Backwork covers Medicare LCDs, Articles, and NCDs and the commercial payer policies it has collected. It does not cover state Medicaid policies. * The API returns what the policies say. It does not make coverage decisions for you. * Confirm codes with `source: "inferred_title_match"` against the policy document before you rely on them. ## Resources [#resources] * [API reference](/docs/api): every endpoint * [SDKs and HTTP clients](/docs/sdks): call the API from any language, or generate a typed client * [Authentication](/docs/authentication): keys and scopes * [Pricing and credits](/docs/pricing): packs and request costs * [Rate limits](/docs/rate-limits): per-minute limits and headers * [Errors](/docs/errors): every error code and whether to retry * [Build with AI](/docs/build-with-ai): Markdown docs, `llms.txt`, and what an agent should check