Endpoints

All endpoints require both auth headers (Authorization and x-api-key). Request bodies may be plain JSON or gzip-compressed JSON unless noted otherwise - see Authentication.

POST /v1/review

Primary endpoint. Submit a bill and receive a full pricing decision with RuleTrace™ calculation detail. Body: plain or gzip JSON.

POST /v1/validate

Validate codes and determine the review jurisdiction before submitting for full review. Same request body as /v1/review. Body: plain or gzip JSON.

POST /v1/facility

Return a list of hospitals or outpatient/surgery centers for accurate institutional pricing. Body: plain JSON only (not gzip).

POST /v1/duplicates

Identify duplicate or potential duplicate service lines. Same request body as /v1/review. Body: plain or gzip JSON.

POST /v1/customcodes

When no CPT or HCPCS code exists (for example, shipping and handling expenses), BillSentry has created custom codes to allow for entry and payment. This API retrieves the list of custom codes used by BillSentry. No request body required.

All paths are appended to your API Endpoint URL - e.g. {your_api_endpoint}/v1/review.

Key naming convention: Request body fields use PascalCase (e.g. Bill, TypeOfBill, CPT1). The API is case-insensitive for inbound requests. Response fields are returned in camelCase.

Schemas and enums on this page are a summary of the values and fields most integrations use. This is not a complete catalog of every request/response class or enum. For the full contract definitions, use the API sample project provided during onboarding (Contracts/DTO and Contracts/Enums) as the definitive reference.

Request Body - `/v1/review`, `/v1/validate`, `/v1/duplicates`

The request is a JSON object. Bill, Services, Claim, and Provider are required. BillOptions and BillHistory are optional.

{
  "Bill": {
    "UniqueID": "1001",
    "TypeOfBill": 0,
    "ProviderType": 1,
    "ZipCode": "90210",
    "BucketList": []
  },
  "BillOptions": {
    "IsLateFee": true,
    "IsNCCI": true,
    "IsMUE": true,
    "IsIgnoreTimelyFiling": false
  },
  "Services": [
    {
      "Line": 1,
      "CPT1": "99213",
      "CPT2": "",
      "ServiceDate": "2025-07-15T00:00:00",
      "QuantityBilled": 1.0,
      "POS": "11",
      "ModifierList": "25",
      "Charge": 175.00,
      "BucketList": []
    }
  ],
  "Claim": {
    "DisplayID": "CLM-001",
    "State": "CA",
    "ZipCode": "90210",
    "StateWhereInjuryOccurred": "CA",
    "DateOfInjury": "2024-06-01T00:00:00"
  },
  "Provider": {
    "TaxID": "123456789",
    "NPI": "1234567890",
    "PracticeState": "CA",
    "PracticeZipCode": "90210"
  },
  "BillHistory": []
}

{
  "Bill": {
    "UniqueID": "3",
    "TypeOfBill": 0,
    "ProviderType": 2,
    "ZipCode": "93291",
    "MedicareNumber": "050057",
    "DRG": "473",
    "AdmitDate": "2025-07-15T00:00:00",
    "DischargeDate": "2025-07-15T00:00:00",
    "BucketList": []
  },
  "BillOptions": {
    "IsLateFee": true,
    "IsIgnoreTimelyFiling": true
  },
  "Services": [
    {
      "Line": 1,
      "CPT1": "120",
      "ServiceDate": "2025-07-15T00:00:00",
      "QuantityBilled": 1.0,
      "POS": "21",
      "Charge": 2316.25,
      "BucketList": []
    }
  ],
  "Claim": {
    "DisplayID": "123-123",
    "State": "CA",
    "ZipCode": "92882",
    "StateWhereInjuryOccurred": "CA"
  },
  "Provider": {
    "TaxID": "123456789",
    "PracticeState": "CA",
    "PracticeZipCode": "93291",
    "BillingZipCode": ""
  },
  "BillHistory": []
}

NPI fields - which box goes where

The request carries several NPI fields. Map them from the CMS-1500 as follows:

CMS-1500 box	Meaning	Request field
17a	Referring provider NPI	Not used
24J	Service-level rendering provider NPI	`Services[].NPI` (per line); `Bill.RenderingProviderNPI` (bill level)
32a	Facility NPI (practice / service-location provider)	`Bill.NPI`
33a	Billing provider NPI	`Bill.BillingProviderNPI`

Provider.NPI should be the rendering provider NPI, or the billing provider NPI if the rendering NPI is not available.

`Bill` object

Field	Type	Required	Notes
`UniqueID`	string (100)	✓	Your internal bill identifier
`ControlNumber`	int		Numeric control number
`Sequence`	int		Sequence number for split bills
`TypeOfBill`	int (enum)	✓	See `TypeOfBill` values
`ProviderType`	int (enum)	✓	See `ProviderType` values
`ZipCode`	string (10)	✓	Provider ZIP code (`12345` or `12345-6789`)
`Historical_BillReviewState`	string (2)		2-letter state the historical bill was reviewed under. Use only inside `BillHistory.Bill`; the current bill’s review state is calculated and returned in `billReviewState`.
`NPI`	string (10)		Facility NPI — CMS-1500 box 32a (practice / service-location provider)
`ProviderSpecialty`	int (enum)		See `ProviderSpecialty` values
`MedicareNumber`	string (6)		CMS certification number (institutional)
`OPCERT`	string (7)		Outpatient certification number
`DRG`	string (3)		DRG code (institutional inpatient)
`DRGLevelOfSeverity`	int		DRG severity level
`AdmitDate`	datetime		Admission date (institutional)
`DischargeDate`	datetime		Discharge date (institutional)
`DischargeStatus`	string (2)		UB-04 discharge status
`ClaimsOfficeReceivedDate`	datetime		Date claims office received the bill
`BillReviewReceivedDate`	datetime		Date bill review was received
`FacilityName`	string (250)		Facility name
`UB92TypeOfBill`	string (3)		UB-04 type of bill code
`TypeOfAdmission`	int (enum)		UB-04 type of admission
`RateCode`	string (4)		Rate code
`ALCDays`	int		Alternate level of care days
`DeviceCredit`	decimal		Device credit amount
`BillFormType`	int (enum)		Form type override
`BillSource`	int (enum)		Source of the bill
`ICDDiagnosticCodes`	string (150)		Comma-separated ICD diagnostic codes
`ICDProcedureCodes`	string (150)		Comma-separated ICD procedure codes
`ScheduledSurgery`	int (enum)		Scheduled surgery flag
`NoticeNonPaymentDate`	datetime		Notice of non-payment date
`RenderingProviderNPI`	string (10)		Rendering provider NPI — CMS-1500 box 24J (bill level)
`RenderingProviderRating`	string (10)		Rendering provider rating
`RenderingProviderTaxonomyCode`	string (20)		Rendering provider taxonomy
`RenderingPhysicianLicenseNumber`	string (20)		Rendering physician license
`BillingProviderNPI`	string (10)		Billing provider NPI — CMS-1500 box 33a
`BillingProviderRating`	string (10)		Billing provider rating
`AttendingProviderRating`	string (10)		Attending provider rating
`AttendingPhysicianLicenseNumber`	string (20)		Attending physician license
`OperatingPhysicianLicenseNumber`	string (20)		Operating physician license
`OtherPhysicianLicenseNumber`	string (20)		Other physician license
`SupervisingProviderRating`	string (10)		Supervising provider rating
`BucketList`	array		Pass `[]` for standard review

`BillOptions` object

All fields are optional and override your tenant’s default configuration.

Field	Type	Default	Notes
`IsLateFee`	bool	`true`	Apply late fee rules
`IsNCCI`	bool	`true`	Apply NCCI edits
`IsMUE`	bool	`true`	Apply MUE limits
`IsDisallowBeforeDOI`	bool	`true`	Disallow services before date of injury
`IsDisallowAfterClosedClaim`	bool	`true`	Disallow services after claim closure
`IsPayAboveCharge`	bool	`true`	Allow allowance to exceed billed charge (state-dependent; not honoured in all states)
`IsIgnoreTimelyFiling`	bool	`false`	Bypass timely filing limits
`IsBoardCertified`	bool	`false`	Provider is board certified
`IsSeparateImplantReimbursement`	bool	`false`	Separately reimburse implants
`IsSelfInsured`	bool	`false`	Self-insured payer
`IsIgnoreClosedFormulary`	bool	`false`	Ignore closed formulary rules
`IsIgnoreLimitVisitRule`	bool	`false`	Ignore visit limit rules
`UseEAPGBaseRate`	bool	`false`	Always use the statewide EAPG base rate (do not look up a facility-specific base rate). NY only
`IsIgnoreHistory`	bool	`false`	Ignore bill history for duplicate check and bill review
`UCRPercentile`	int	`0`	UCR percentile to apply (e.g. `80`)
`IsSurchargePaidDirectlyToPool`	bool	`false`	Surcharge paid directly to pool (NY only)
`IsAssessmentByRPT`	bool	`false`	Assessment performed by RPT (FL / OK / RI only)
`AllowRevCodeWithoutChargemaster`	bool	`false`	Allow revenue codes without a chargemaster code (PA only)
`IsPriorAuthorization`	bool	`false`	Prior authorization obtained
`IsDocumentation`	bool	`false`	Required documentation provided

`Services` array - per service line

Field	Type	Required	Notes
`Line`	int	✓	Line number (1-based)
`CPT1`	string (20)	✓	CPT, HCPCS, or revenue code
`CPT2`	string (20)		Secondary / compound code
`ServiceDate`	datetime	✓	Date of service
`QuantityBilled`	decimal	✓	Units billed
`QuantityOverride`	decimal		Override calculated quantity - omit if not overriding
`Charge`	decimal	✓	Billed charge for this line
`POS`	string (2)		Place of service code
`TOS`	string (2)		Type of service code
`ModifierList`	string (20)		Comma-separated modifiers (e.g. `"25,59"`)
`PPOAllowance`	decimal		PPO contracted rate - caps allowance if provided; omit or `null` to skip PPO allowance. Alternatively, pass a `BucketDTO` with `BucketHierarchyID = 10` (PPO) and `ReasonCodesRequest` in `BucketList`.
`Allowance`	decimal		Prior allowance (for history/re-review)
`TaxCharge`	decimal		Tax amount billed
`TaxAllowance`	decimal		Tax allowance
`TaxRate`	decimal		Tax rate
`Duplicate`	int (enum)		Duplicate flag
`PriorAuthorization`	int (enum)		Prior auth status for this line
`Documentation`	int (enum)		Documentation status for this line
`InvoiceCost`	decimal		Invoice cost (implants/devices)
`ShippingAndHandling`	decimal		Shipping and handling charge
`NPI`	string (10)		Service-level rendering provider NPI — CMS-1500 box 24J
`ChargemasterCode`	string (50)		Facility chargemaster code for outpatient / ASC lines (PA only)
`TwoSurgeonPercent`	decimal		Percentage applied for two-surgeon (modifier 62) pricing (NY only)
`IsCompoundSterile`	bool		Compound sterile flag (pharmacy)
`CompoundingTime`	int		Compounding time in minutes
`CompoundingFee`	decimal		Compounding fee
`CompoundUniqueID`	string (20)		Compound drug unique identifier
`SterilizationFee`	decimal		Sterilization fee
`ContainerCount`	int		Number of containers (pharmacy)
`DaysSupply`	int		Days supply (pharmacy)
`DispensedAsWritten`	int (enum)		DAW code (pharmacy)
`IsRefill`	bool		Refill prescription
`Historical_QuantityUsed`	decimal		Quantity actually paid for this line when it was previously reviewed (history service lines only)
`Historical_ServiceState`	object		Prior `ServiceStateDTO` for this history line
`Historical_BucketTotalList`	array		Prior `BucketTotalDTO` list for this history line
`BucketList`	array		Pass `[]` for standard review

`Claim` object

Field	Type	Notes
`DisplayID`	string (50)	Your claim identifier
`State`	string (2)	Claimant state
`ZipCode`	string (10)	Claimant ZIP code (`12345` or `12345-6789`)
`StateWhereInjuryOccurred`	string (2)	State where the injury occurred. Primary input for jurisdiction; when blank, jurisdiction falls back to `Claim.State`, then provider state, then `Bill.ZipCode`
`DateOfInjury`	datetime	Date of injury
`ClosedDate`	datetime	Claim closure date
`Age`	int	Claimant age

`Provider` object

Field	Type	Required	Notes
`TaxID`	string (50)	✓	Provider federal tax ID
`NPI`	string (10)		Rendering provider NPI (or billing provider NPI if not available)
`License`	string (15)		Provider license number
`PracticeName`	string (500)		Practice name
`PracticeAddress1`	string (200)		Practice address line 1
`PracticeAddress2`	string (200)		Practice address line 2
`PracticeCity`	string (200)		Practice city
`PracticeState`	string (2)		Practice state
`PracticeZipCode`	string (10)		Practice ZIP (`12345` or `12345-6789`)
`BillingName`	string (500)		Billing name
`BillingAddress1`	string (200)		Billing address line 1
`BillingAddress2`	string (200)		Billing address line 2
`BillingCity`	string (200)		Billing city
`BillingState`	string (2)		Billing state
`BillingZipCode`	string (10)		Billing ZIP (`12345` or `12345-6789`)

`BillHistory` array

Pass prior bills from the same claim to enable duplicate detection and visit-limit enforcement. Each entry contains a Bill object (set Historical_BillReviewState to the prior review state), optional ProviderTaxID / ProviderNPI identifying the historical bill’s provider, and a Services array whose lines include Historical_QuantityUsed, Historical_ServiceState, and Historical_BucketTotalList from the prior review.

"BillHistory": [
  {
    "Bill": { "Historical_BillReviewState": "CA", "ProviderType": 1, ... },
    "ProviderTaxID": "123456789",
    "ProviderNPI": "1234567890",
    "Services": [ { "Line": 1, "CPT1": "99213", "Historical_QuantityUsed": 1.0, "Historical_ServiceState": {}, "Historical_BucketTotalList": [], ... } ]
  }
]

Common enum values

The tables below cover the enum values most integrations need day to day. Additional enums and DTO fields live in the API sample project provided during onboarding - treat that project as the complete list.

`TypeOfBill` values

Value	Name
`0`	Workers Comp
`1`	UCR
`2`	OWCP
`3`	Auto

`ProviderType` values

Value	Name	Value	Name
`0`	Unknown	`29`	Nurse Practitioner
`1`	Physician	`30`	Nursing Facility
`2`	Inpatient	`31`	Occupational Therapist
`3`	Outpatient	`32`	Occupational Therapist Assistant
`4`	Surgery Center	`33`	Optometrist
`5`	Acupuncturist	`34`	Osteopath
`6`	Advanced Practice Registered Nurse	`35`	Other
`7`	Ambulance Transport Services	`36`	Pain Management
`8`	Anesthesiologist	`37`	Pathology Laboratory
`9`	Anesthesiologist Assistant	`38`	Pharmacy
`10`	Athletic Trainer	`39`	Physical Therapist
`11`	Audiologist	`40`	Physical Therapist Assistant
`12`	Behavioral Health Counselor	`41`	Physician Assistant
`13`	Certified Nurse Assistant	`42`	Podiatrist
`14`	Certified Registered Nurse Anesthetist	`43`	Professional Clinical Counselor
`15`	Certified Rehabilitation Counselor	`44`	Psychiatric Nurse Practitioner
`16`	Chiropractor	`45`	Psychiatrist
`17`	Clinical Nurse Specialist	`46`	Psychologist
`18`	Clinical Psychologist	`47`	Radiology Facility
`19`	Dentist	`48`	Registered Nurse
`20`	Dietitian	`49`	Registered Nurse First Assistant
`21`	Home Health	`50`	Rehab Nurse
`22`	Independent Social Worker	`51`	Respiratory Therapist
`23`	Licensed Massage Therapist	`52`	Skilled Nursing Facility
`24`	Licensed Surgical Assistant	`53`	Social Worker
`25`	Medical Clinic	`54`	Speech Therapist
`26`	Medical Supplies	`55`	Urgent Care Center
`27`	Mental Health Facility	`56`	Vocation Rehabilitation Case Management Intern
`28`	Mental Health Intern

`ProviderSpecialty` values

Optional refinement of ProviderType. Values 37–39 were added in the latest API release.

Value	Name	Value	Name
`0`	Unknown	`20`	Occupational Therapist
`1`	Addiction Medicine	`21`	Ophthalmology
`2`	Addictionology	`22`	Optometry
`3`	Anesthesiology	`23`	Oral Surgery
`4`	Cardiovascular Diseases Cardiology	`24`	Ortho Sports Medicine
`5`	Certified Nurse Anesthetist	`25`	Orthodontics
`6`	Chemotherapy	`26`	Orthopedic Surgery
`7`	Chiropractic	`27`	Other
`8`	Clinical Psychologist	`28`	Outpatient Hospital
`9`	Dentistry	`29`	Pain Management
`10`	Emergency Medicine	`30`	Physical Medicine and Rehabilitation
`11`	Inpatient Hospital	`31`	Psychiatrist
`12`	Marriage Family Child Counselors	`32`	Psychiatry
`13`	Massage Therapy	`33`	Psychologist
`14`	Maxillofacial Surgery	`34`	Pulmonary Disease
`15`	Neurological Surgery	`35`	Skilled Nursing Facility
`16`	Neurology	`36`	Social Worker
`17`	Neuropsychiatry	`37`	Physiatrist
`18`	Obstetrics and Gynecology Maternity	`38`	Independent Medical Examiner
`19`	Occupational Medicine	`39`	Naturopath

Request Body - `/v1/facility`

This endpoint accepts plain JSON - do not gzip-compress the body or set Content-Encoding: gzip.

{
  "state": "CA",                   // 2-letter state code, required
  "providerType": 2,               // int enum - 2=Inpatient, 3=Outpatient, 4=Surgery Center
  "effectiveDate": "2025-07-15T00:00:00"
}

Request Body - `/v1/customcodes`

No request body. Send auth headers only (Authorization and x-api-key). The response returns the list of custom codes used by BillSentry (for example, shipping and handling) when no standard CPT®/HCPCS code exists.

Response notes - secondary endpoints

Endpoint	What you get back
`POST /v1/validate`	Validation / jurisdiction result for the submitted bill structure (same request body as `/v1/review`). Use before full review when you need early structural checks.
`POST /v1/duplicates`	Duplicate / potential-duplicate findings for service lines (same request body as `/v1/review`, including optional `BillHistory`).
`POST /v1/facility`	List of matching facilities (hospitals / outpatient / surgery centers) for the requested state, provider type, and effective date.
`POST /v1/customcodes`	BillSentry custom codes used when no standard CPT®/HCPCS code exists (for example, shipping and handling).

Full field-level response documentation is provided below for POST /v1/review (the primary integration path). For secondary endpoint response samples during onboarding, contact support@billsentry.com.

Response Structure - `/v1/review`

A successful review returns HTTP 200 with a gzip-compressed JSON body (Content-Encoding: gzip). Most HTTP clients decompress this automatically - ensure your client sends Accept-Encoding: gzip or handles decompression explicitly.

Top-level response fields

Field	Type	Description
`error`	string	Non-null if the review failed - check this first
`qrCodeID`	string	Unique review identifier - use for audit trails and dispute tracking
`qrCodeURL`	string	Shareable link to the hosted RuleTrace™ report
`logHTML`	string	Self-contained HTML report showing full RuleTrace™ calculation logic
`bill`	object	Bill-level results - see `bill` fields below
`services`	array	Per-line results - see `services[]` fields below
`serviceReasonCodes`	object	Map of line number → list of `ServiceReasonCodeDTO` objects for all lines
`logHeader`	object	Metadata about the review run
`logDetails`	array	Structured log entries for the review calculation

`bill` response fields

Field	Type	Description
`uniqueID`	string	Echoed from request
`billReviewState`	string	State that was used for fee schedule lookup
`reviewedToState`	string	State actually reviewed under (may differ from submitted)
`jurisdictionState`	string	Jurisdiction state determined by the engine from `Claim.StateWhereInjuryOccurred`, then `Claim.State`, then provider state, then `Bill.ZipCode`; not supplied by the caller
`isPriorAuthorizationRequired`	bool	True if any service line requires prior auth
`isDocumentationRequired`	bool	True if any service line requires documentation
`totalCharge`	decimal	Sum of all billed charges
`totalAllowance`	decimal	Total approved reimbursement (PPO-capped if applicable)
`totalUncappedAllowance`	decimal	Allowance before PPO cap
`totalReduction`	decimal	Total reduction from billed charges
`totalPrePPOAllowance`	decimal	Allowance before PPO adjustment
`totalUncappedPrePPOAllowance`	decimal	Pre-PPO allowance before any cap
`totalSurcharge`	decimal	Total surcharge amount
`totalTaxCharge`	decimal	Total tax charge
`totalTaxAllowance`	decimal	Total tax allowance
`totalTaxReduction`	decimal	Total tax reduction
`fromServiceDate`	datetime	Earliest service date on the bill
`toServiceDate`	datetime	Latest service date on the bill
`processedDate`	datetime	Date/time the review was processed
`facilityName`	string	Resolved facility name
`billReviewProcessingTime`	integer	Processing time in milliseconds
`isNYC81FormRequired`	bool	NYC C-81 form required
`isNYC84FormRequired`	bool	NYC C-84 form required
`nmLocationCode`	string	New Mexico location code
`reasonCodes`	array	Bill-level reason code IDs
`bucketList`	array	Bill-level RuleTrace™ rule trace entries - see Rule Trace Entry below
`bucketTotalList`	array	Bill-level bucket totals
`billState`	object	State-specific bill metadata

`services[]` response fields - per line

Field	Type	Description
`line`	int	Line number matching the submitted service
`cpt1`	string	Resolved CPT / revenue code used for pricing
`originalCPT1`	string	CPT1 as submitted (before any code substitution)
`description1`	string	Description of CPT1
`descriptionSource1`	int (enum)	Source of the CPT1 description
`cpt2`	string	Resolved secondary code
`originalCPT2`	string	CPT2 as submitted
`description2`	string	Description of CPT2
`descriptionSource2`	int (enum)	Source of the CPT2 description
`quantityBilled`	decimal	Quantity as submitted
`quantityUsed`	decimal	Quantity used for pricing (may differ after MUE)
`charge`	decimal	Billed charge for this line
`allowance`	decimal	Approved reimbursement (PPO-capped if applicable)
`uncappedAllowance`	decimal	Allowance before PPO cap
`reduction`	decimal	Reduction amount for this line
`prePPOAllowance`	decimal	Allowance before PPO adjustment
`uncappedPrePPOAllowance`	decimal	Pre-PPO allowance before any cap
`taxCharge`	decimal	Tax charge for this line
`taxAllowance`	decimal	Tax allowance for this line
`taxReduction`	decimal	Tax reduction for this line
`taxRate`	decimal	Tax rate applied
`invoiceCost`	decimal	Invoice cost (implants/devices)
`isPriorAuthorizationRequired`	bool	Prior auth required for this line
`isDocumentationRequired`	bool	Documentation required for this line
`duplicate`	int (enum)	Duplicate status
`cptUsedForPayment`	int (enum)	Which CPT code was used for payment calculation
`chargemasterCode`	string	Resolved chargemaster code
`chargemasterDescription`	string	Chargemaster code description
`reasonCodes`	string	Comma-separated reason code IDs for this line
`carcReasonCodes`	string	Comma-separated CARC codes for this line
`stateReasonCodes`	string	Comma-separated state-specific reason codes
`reasonCodesDTO`	array	Full reason code objects - see Reason Code below
`bucketList`	array	Line-level RuleTrace™ rule trace entries - see Rule Trace Entry below
`bucketTotalList`	array	Line-level bucket totals
`serviceState`	object	State-specific service metadata

Reason Code fields

Field	Type	Description
`id`	int	Reason code ID (1000-4999 system; 5000-99999 custom)
`displayID`	string	Display identifier (may differ from `id`)
`shortDescription`	string	Human-readable summary
`longDescription`	string	Full explanation
`bucketHierarchyID`	int	Associated rule bucket
`cARC_ID`	string	Corresponding CARC code
`cARCDescription`	string	CARC code description
`cARCGroupCode`	string	CARC group code
`stateReasonCodes`	object	Map of `state → state-specific reason code`

Rule Trace Entry fields

Each entry in bucketList represents one step in the pricing calculation.

Field	Type	Description
`line`	int	Service line number
`bucketHierarchyID`	int	Rule hierarchy identifier
`bucketHierarchyDescription`	string	Human-readable name of the rule bucket
`bucketEntryPoint`	int (enum)	How this bucket was triggered
`bucketSource`	int (enum)	Source of the pricing value - see `BucketSource` values
`bucketSourceID`	string	Source identifier (fee schedule ID, rule ID, etc.)
`sourceDescription`	string	Human-readable source description
`sourceValue`	decimal	Raw source value
`sourcePercent`	decimal	Source percentage applied
`sourceAdditional`	decimal	Additional source value
`allowance`	decimal	Allowance from this bucket
`uncappedAllowance`	decimal	Uncapped allowance from this bucket
`percentApplied`	decimal	Percentage applied in this step
`reduction`	decimal	Reduction from this bucket
`bucketOverride`	int (enum)	Override type applied
`fullRuleName`	string	Full name of the pricing rule
`triggerCode`	string	Code that triggered this rule
`triggerDate`	datetime	Date of service for the `triggerCode`
`percentOfCharge`	decimal	Allowance expressed as percent of charge
`requirementURL`	string	Link to the fee schedule or regulation source
`reasonCodes`	string	Comma-separated reason codes from this bucket
`reasonCodesResult`	array	Full reason code objects for this entry

Rule Trace - `bucketSource` values

Value	Name	Description
`0`	Unknown
`1`	Charge	Allowance equals the billed charge
`2`	Calculated	Fee schedule or rule-based calculation
`3`	User	Manual override
`4`	PPO	PPO contracted rate
`5`	OSR	Other source rate
`6`	Utilization Review	UR determination
`7`	Adjuster	Adjuster override
`8`	Customer Rule	Tenant-specific custom rule
`9`	External	External pricing source
`10`	Bill Level	Bill-level rule (not line-specific)
`11`	Modifier	Modifier-driven adjustment

Duplicate Result fields

POST /v1/duplicates returns a DuplicateResultDTO containing DuplicateResultsByService, a map keyed by service line number:

Field	Type	Description
`duplicate`	int (enum)	Duplicate status
`originalService`	object	The matching `ServiceDTO` from history
`originalService_UniqueID`	string	Unique ID of the bill containing the original service
`originalService_ControlNumber`	int	Control number of the original bill
`originalService_Sequence`	int	Sequence number of the original bill

CPT® © 2025 American Medical Association. All Rights Reserved.Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.CPT is a registered trademark of the American Medical Association.U.S. Government Rights - This product includes CPT and/or CPT® Changes which are commercial technical data, which was developed exclusively at private expense by the American Medical Association, 330 North Wabash Avenue, Chicago, Illinois 60611. The American Medical Association does not agree to license CPT to the Federal Government based on the license in FAR 52.227-14 (Data Rights - General) and DFARS 252.227-7015 (Technical Data - Commercial Items) or any other license provision. The American Medical Association reserves all rights to approve any license with any Federal agency.

Getting Started

API Reference

Production Guide

Resources

POST /v1/review

POST /v1/validate

POST /v1/facility

POST /v1/duplicates

POST /v1/customcodes

Request Body - `/v1/review`, `/v1/validate`, `/v1/duplicates`

NPI fields - which box goes where

`Bill` object

`BillOptions` object

`Services` array - per service line

`Claim` object

`Provider` object

`BillHistory` array

Common enum values

`TypeOfBill` values

`ProviderType` values

`ProviderSpecialty` values

Request Body - `/v1/facility`

Request Body - `/v1/customcodes`

Response notes - secondary endpoints

Response Structure - `/v1/review`

Top-level response fields

`bill` response fields

`services[]` response fields - per line

Reason Code fields

Rule Trace Entry fields

Rule Trace - `bucketSource` values

Duplicate Result fields

POST /v1/review

POST /v1/validate

POST /v1/facility

POST /v1/duplicates

POST /v1/customcodes

​Request Body - /v1/review, /v1/validate, /v1/duplicates

​NPI fields - which box goes where

​Bill object

​BillOptions object

​Services array - per service line

​Claim object

​Provider object

​BillHistory array

​Common enum values

​TypeOfBill values

​ProviderType values

​ProviderSpecialty values

​Request Body - /v1/facility

​Request Body - /v1/customcodes

​Response notes - secondary endpoints

​Response Structure - /v1/review

​Top-level response fields

​bill response fields

​services[] response fields - per line

​Reason Code fields

​Rule Trace Entry fields

​Rule Trace - bucketSource values

​Duplicate Result fields

Request Body - `/v1/review`, `/v1/validate`, `/v1/duplicates`

NPI fields - which box goes where

`Bill` object

`BillOptions` object

`Services` array - per service line

`Claim` object

`Provider` object

`BillHistory` array

Common enum values

`TypeOfBill` values

`ProviderType` values

`ProviderSpecialty` values

Request Body - `/v1/facility`

Request Body - `/v1/customcodes`

Response notes - secondary endpoints

Response Structure - `/v1/review`

Top-level response fields

`bill` response fields

`services[]` response fields - per line

Reason Code fields

Rule Trace Entry fields

Rule Trace - `bucketSource` values

Duplicate Result fields