Check Medicare DME coverage for a HCPCS code
check_dme_coverageRead-onlyIdempotent
Look up Medicare coverage for one durable medical equipment (DME) HCPCS Level II code in a US state on a date of service. Returns the Local Coverage Determination (LCD) and policy articles in force on that date with CMS links, whether the code is on the Medicare prior authorization list, and the documentation-requirements status. Medicare fee-for-service DME only. Does not decide whether a specific claim will be paid. Codes only, no patient data.
Input Schema
TableJSON Schema
| Name | Required | Description | Default |
|---|---|---|---|
| hcpcs | Yes | HCPCS Level II code, e.g. E0601 (CPAP), K0001 (wheelchair) | |
| state | Yes | Two-letter US state of the beneficiary or supplier, e.g. CO | |
| date_of_service | No | YYYY-MM-DD. Defaults to today. |
Output Schema
TableJSON Schema
| Name | Required | Description | Default |
|---|---|---|---|
| hcpcs | Yes | ||
| state | No | ||
| receipt | No | ||
| upgrade | Yes | ||
| citation | Yes | ||
| coverage | Yes | ||
| governing | Yes | ||
| descriptor | No | ||
| date_of_service | Yes | ||
| prior_authorization | No | ||
| documentation_requirements | Yes |