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Verzi Health

Check Medicare DME coverage for a HCPCS code

check_dme_coverage
Read-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
NameRequiredDescriptionDefault
hcpcsYesHCPCS Level II code, e.g. E0601 (CPAP), K0001 (wheelchair)
stateYesTwo-letter US state of the beneficiary or supplier, e.g. CO
date_of_serviceNoYYYY-MM-DD. Defaults to today.

Output Schema

TableJSON Schema
NameRequiredDescriptionDefault
hcpcsYes
stateNo
receiptNo
upgradeYes
citationYes
coverageYes
governingYes
descriptorNo
date_of_serviceYes
prior_authorizationNo
documentation_requirementsYes

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