interpretation_requirement

Who a payer's own policy says may FURNISH and INTERPRET a code. Use this for "can a primary care doctor bill this", "does this need a radiologist", or "who has to read the study". This is not a coverage question: a code whose interpretation is unrestricted may still be refused, and this tool says nothing about whether anyone pays. Codes: 91200, 0689T, 0690T, 76981, 76982, 76983, 76705, 0002M, 0003M, 81517, 0014M, 80076. `0689` is not a code, `0689T` is. WHAT THE CORPUS IS, because it decides what an empty answer means. Medicare Local Coverage Articles and nothing else. No commercial payer policy is held at all. Of roughly a dozen Medicare contractors only some publish the IDTF Credentialing Matrix, which is the register that states, per code, the supervision level, the supervising physician's required qualification and the technician's required credential. AN ANSWER COMES BACK IN ONE OF TWO SHAPES AND THEY ARE NOT INTERCHANGEABLE. A code with policy carries `requirements`, one record per contractor, each with the publisher's verbatim words, the contractor it binds, the enrolment type it governs, and a source_url. A code without carries `not_in_corpus` instead, and that object has NO field a requirement could be written into. Do not supply one. `not_in_corpus` means nothing in THIS corpus states a requirement; it does not mean no requirement exists, and writing that a code is unrestricted on the strength of it states a fact about a payer's rules that nobody has read. THREE SCOPES BIND EVERY RECORD and dropping any one inverts the answer. A record binds its own contractor, not the nation. The IDTF matrix governs Independent Diagnostic Testing Facilities, not physician offices generally. And it is Medicare, so it does not speak to a commercial rejection. Every answer carries coverage_frontier naming what was searched, so an absence is scoped rather than global. A code outside the searched vocabulary is refused rather than reported absent: this world cannot report the absence of something it never looked for.

Use this form for new arguments. Follow concrete links for known values. Fetch-only readers may be unable to submit new URLs.

Exact input contract

{
  "additionalProperties": false,
  "properties": {
    "code": {
      "description": "The billing code to look up, from this world's closed vocabulary.",
      "enum": [
        "0002M",
        "0003M",
        "0014M",
        "028",
        "029",
        "030",
        "0319U",
        "0320U",
        "0362T",
        "0540U",
        "0689T",
        "0690T",
        "20930",
        "20936",
        "22551",
        "22552",
        "22554",
        "22558",
        "22585",
        "22600",
        "22610",
        "22612",
        "22614",
        "22630",
        "22633",
        "22634",
        "22840",
        "22842",
        "22845",
        "22853",
        "22854",
        "27125",
        "27130",
        "27235",
        "27236",
        "27244",
        "27245",
        "27447",
        "3074F",
        "3075F",
        "3077F",
        "3078F",
        "3079F",
        "3080F",
        "402",
        "426",
        "427",
        "428",
        "429",
        "430",
        "447",
        "448",
        "450",
        "451",
        "453",
        "454",
        "455",
        "456",
        "457",
        "458",
        "459",
        "460",
        "471",
        "472",
        "473",
        "50200",
        "50360",
        "50365",
        "50370",
        "62380",
        "63005",
        "63030",
        "63042",
        "63047",
        "63048",
        "63052",
        "63056",
        "70450",
        "72131",
        "72141",
        "72148",
        "72158",
        "73502",
        "73521",
        "76705",
        "76770",
        "76981",
        "76982",
        "76983",
        "80048",
        "80053",
        "80061",
        "80076",
        "81479",
        "81517",
        "82043",
        "83036",
        "83718",
        "83880",
        "84443",
        "90785",
        "90791",
        "90792",
        "90832",
        "90833",
        "90834",
        "90836",
        "90837",
        "90838",
        "90839",
        "90840",
        "90846",
        "90847",
        "90853",
        "90887",
        "90935",
        "90937",
        "90945",
        "90960",
        "90961",
        "91200",
        "93000",
        "93010",
        "93306",
        "93307",
        "93308",
        "93784",
        "93786",
        "93788",
        "93790",
        "93797",
        "93798",
        "93880",
        "93975",
        "96127",
        "96130",
        "96131",
        "96136",
        "96137",
        "96138",
        "96139",
        "97012",
        "97014",
        "97032",
        "97035",
        "97110",
        "97112",
        "97116",
        "97140",
        "97151",
        "97153",
        "97155",
        "97161",
        "97162",
        "97163",
        "97164",
        "97530",
        "97535",
        "97750",
        "98975",
        "98976",
        "98977",
        "98978",
        "98979",
        "98980",
        "98981",
        "98984",
        "98985",
        "99091",
        "99213",
        "99214",
        "99215",
        "99283",
        "99284",
        "99285",
        "99408",
        "99409",
        "99453",
        "99454",
        "99457",
        "99458",
        "99473",
        "99474",
        "99484",
        "99487",
        "99490",
        "99491",
        "99492",
        "99493",
        "99494",
        "99495",
        "99496",
        "G0283",
        "G0396",
        "G0397",
        "G0422",
        "G0423",
        "G2067",
        "G2068",
        "G2069",
        "G2070",
        "G2074",
        "G2080",
        "G2214",
        "H0001",
        "H0015",
        "H0020",
        "H0038",
        "H0039",
        "H2011",
        "H2017",
        "S9480",
        "T1016"
      ],
      "type": "string"
    }
  },
  "required": [
    "code"
  ],
  "type": "object"
}

Ready links