2025-06 Coverage API 1.5 Release Notes

June 17, 2025

Overview

The Coverage API 1.5 introduces 3 new endpoints related to Local Coverage Articles and LCDs that can be found on the MCD (Medicare Coverage Database).

New Features

Local Coverage Document View Endpoints:
  1. Local Coverage Article Endpoint: (/v1/data/article/) Retrieves detailed document level information for Articles.
    1. /v1/data/article/future-retire
    2. /v1/data/article/related-documents
    3. /v1/data/article/related-ncd-documents
    4. /v1/data/article/related-source-icd9
    5. /v1/data/article/bill-codes
    6. /v1/data/article/code-table
    7. /v1/data/article/contractor
    8. /v1/data/article/hcpc-code
    9. /v1/data/article/hcpc-code-group
    10. /v1/data/article/hcpc-modifier
    11. /v1/data/article/hcpc-modifier-group
    12. /v1/data/article/icd10-covered
    13. /v1/data/article/icd10-covered-group
    14. /v1/data/article/icd10-noncovered
    15. /v1/data/article/icd10-noncovered-group
    16. /v1/data/article/icd10-pcs-code
    17. /v1/data/article/icd10-pcs-code-group
    18. /v1/data/article/other-coding-group
    19. /v1/data/article/primary-jurisdiction
    20. /v1/data/article/response-comment
    21. /v1/data/article/revenue-code
    22. /v1/data/article/revision-history
    23. /v1/data/article/sticky-note
    24. /v1/data/article/urls
  2. Local Coverage LCD Endpoint: (/v1/data/lcd/) Retrieves detailed document level information for LCDs. 
    1. /v1/data/lcd/related-documents
    2. /v1/data/lcd/related-ncd-documents
    3. /v1/data/lcd/future-retire
    4. /v1/data/lcd/related-source-icd9
    5. /v1/data/lcd/advisory-committee
    6. /v1/data/lcd/contractor
    7. /v1/data/lcd/hcpc-code-group
    8. /v1/data/lcd/hcpc-code
    9. /v1/data/lcd/reason-change
    10. /v1/data/lcd/requestor-letters
    11. /v1/data/lcd/revision-history
    12. /v1/data/lcd/sticky-note
    13. /v1/data/lcd/synopsis-changes
    14. /v1/data/lcd/urls
    15. /v1/data/lcd/primary-jurisdiction
    16. /v1/data/lcd/tracking-sheet
    17. /v1/data/lcd/attachments
  3. Local Coverage Update Period Endpoint: (/v1/metadata/update-period/) Returns the start and end dates for the current data capture period and previous ones, providing the date range for a dataset (e.g., 5/5 to 5/12).

Deprecations

There are no deprecations in this release.

2025-06 Coverage API 1.4 Release Notes

June 3, 2025

Overview

The Coverage API 1.4 introduces a new endpoint related to the Local Coverage SAD (Self-Administered Drug) Exclusion List Report that can be found on the MCD (Medicare Coverage Database) Reports page: https://www.cms.gov/medicare-coverage-database/reports/reports.aspx Additionally, this release includes a new License Agreement endpoint. This endpoint issues the required token to access the Local Coverage SAD Exclusion List endpoint and will be used for future endpoints that require acceptance of a license agreement.

New Features

Reports:
  1. Local Coverage SAD Exclusion List Endpoint: (/v1/reports/local-coverage-sad-exclusion-list/) This endpoint retrieves a list of Local Coverage Self-Administered Drug (SAD) Exclusion List Articles.
  2. License Agreement Endpoint: (/v1/metadata/license-agreement/) This endpoint retrieves a token used to access certain endpoints, including the Local Coverage SAD Exclusions List endpoint.

Deprecations

There are no deprecations in this release.

2025-05 Coverage API 1.3 Release Notes

May 13, 2025

Overview

The Coverage API 1.3 introduces enhancements aimed at providing new endpoints related to National Coverage Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) Meetings, Technology Assessments (TAs), National Coverage Determinations (NCDs), National Coverage Analyses (NCAs), Coding Analyses for Labs (CALs), and Medicare Coverage Documents that can be found in the MCD (Medicare Coverage Database) Search: https://www.cms.gov/medicare-coverage-database/search-results.aspx.

New Features

National Coverage Document View Endpoints:
  1. MEDCAC Meetings Endpoint: (/v1/data/medcac-meeting/) This endpoint offers MEDCAC Meeting information.
    1. Related Material Endpoint: (/v1/data/medcac-meeting/related-material)
    2. Related E-Web Endpoint (/v1/data/medcac-meeting/related-eweb-material)
    3. Related NCA Endpoint (/v1/data/medcac-meeting/related-nca)
    4. Related TA Endpoint (/v1/data/medcac-meeting/related-ta)
  2. Technology Assessment Endpoint: (/v1/data/technology-assessment/) This endpoint offers detailed information for Technology Assessments (TAs).
    1. Related NCAs: (/v1/data/technology-assessment/related-ncas)
    2. Related Material: (/v1/data/technology-assessment/related-material)
    3. Related Web Material: (/v1/data/technology-assessment/related-web-material)
    4. Related MEDCAC: (/v1/data/technology-assessment/related-medcac)
  3. National Coverage Determinations: (NCDs) Endpoint: (/v1/data/ncd/)This endpoint offers NCD document specific information.
    1. Related NCAs: (/v1/data/ncd/related-ncas/)
    2. Related CALs: (/v1/data/ncd/related-cals/)
    3. Related CPIs: (/v1/data/ncd/related-cpis/)
    4. Other Versions: (/v1/data/ncd/other-versions/)
  4. National Coverage Analyses (NCAs) Endpoint: (/v1/data/nca/) This endpoint offers NCA document specific information.
    1. Tracking Sheet: (/v1/data/nca/tracking-sheet)
    2. Related NCDs: (/v1/data/nca/related-ncd)
    3. Related TAs: (/v1/data/nca/related-ta)
    4. Related MEDCACs: (/v1/data/nca/related-medcac)
    5. History: (/v1/data/nca/history)
    6. Related Comments: (/v1/data/nca/related-comments)
  5. Medicare Coverage Document Endpoint: (/v1/data/medicare-coverage-document/) This endpoint offers document specific information for Medicare Coverage Documents.
    1. Related Comments: (/v1/data/medicare-coverage-document/)
  6. Coding Analyses for Labs (CALs) Endpoint: (/v1/data/medicare-coverage-document/) This endpoint offers document specific information for CALs.
    1. Tracking Sheet: (/v1/data/cal/tracking-sheet)
    2. Related NCDs: (/v1/data/cal/related-ncd)
    3. Related TAs: (/v1/data/cal/related-ta)
    4. Related MEDCACs: (/v1/data/cal/related-medcac)
    5. History: (/v1/data/cal/history)
    6. Related Comments: (/v1/data/cal/related-comments)

Deprecations

There are no deprecations in this release.

2024-08 Coverage API 1.2 Release Notes

August 13, 2024

Overview

The Coverage API 1.2 introduces enhancements aimed at providing new endpoints related to National Coverage Reports that can be found on the MCD (Medicare Coverage Database) https://www.cms.gov/medicare-coverage-database/reports/reports.aspx .

New Features

Reports:
  1. National Coverage - Annual Report Endpoint: (v1/reports/national-coverage-annual/) This endpoint offers a list of National Coverage documents with parameters for document type and year. If a year is not selected, the current year will be the default. The National Coverage Annual Report lists National Coverage documents that were created or updated in each calendar year.
  2. National Coverage - NCA/CAL Reports Endpoint: (v1/reports/national-coverage-ncacal/) This endpoint offers a list of NCAs/CALs along with parameters for Document type(s) and status. NCAs and CALs are documents that support the National Coverage Determination (NCD) process.
  3. National Coverage - NCD Report Endpoint: (v1/reports/national-coverage-ncd/) This endpoint offers a list of National Coverage Determination (NCD) documents. NCDs are national policy granting, limiting, or excluding Medicare coverage for a specific medical item or service. These are developed and published by CMS and apply to all states. NCDs are made through an evidence-based process, with opportunities for public participation.
  4. National Coverage - Medicare Coverage Documents Report Endpoint: (v1/reports/national-coverage-medicare-coverage-documents/) This endpoint offers a list of National Coverage Medicare Coverage Documents. These documents are published by CMS to help relay information that is related to coverage at a national level.
  5. National Coverage - MEDCAC Meetings Report Endpoint: (v1/reports/national-coverage-medcac-meetings/) This endpoint offers a list of National Coverage MEDCAC meetings. Medicare Evidence Development & Coverage Advisory Committees (MEDCACs), provide independent guidance and expert advice.
  6. National Coverage - Technology Assessments Report Endpoint: (v1/reports/national-coverage-technology-assessments/) This endpoint offers a list of National Coverage Technology Assessments (TAs). TAs support the National Coverage Determination (NCD) process and often focus on the quality of the evidence for a given technology.

Deprecations

There are no deprecations in this release.

2024-07 Coverage API 1.1 Release Notes

July 11, 2024

Overview

The Coverage API 1.1 introduces significant enhancements aimed at providing new endpoints related to Local Coverage Reports that can be found on the MCD (Medicare Coverage Database) https://www.cms.gov/medicare-coverage-database/reports/reports.aspx .

New Features

Metadata:
  1. State Metadata Endpoint: (v1/metadata/states) retrieves the state_id for LCD and Article Endpoints.
  2. Contract Subtype Metadata Endpoint: (v1/metadata/contract-subtype) Retrieves all possible values for the contract subtype field.
Reports:
  1. Local Coverage - Proposed LCDs Reports Endpoint: (v1/reports/local-coverage-proposed-lcds) This endpoint offers a list of Proposed Local Coverage Determinations (LCDs) along with parameters for Contractor, Contract Subtype, State, and Status. Medicare Administrative Contractors (MACs) publish Proposed LCDs before an LCD becomes final.
  2. Local Coverage - Final LCDs Reports Endpoint: (v1/reports/local-coverage-final-lcds) This endpoint offers a list of Final Local Coverage Determinations (LCDs) along with parameters for Contractor, Contract Subtype, State, and Status. LCDs are decisions made by a MAC regarding what is reasonable and necessary and, therefore, covered by Medicare within their jurisdiction.
  3. Local Coverage - Articles Reports Endpoint: (v1/reports/local-coverage-articles) This endpoint provides a list of Articles along with parameters for Contractor, Contract Subtype, State, and Status. Articles include billing, coding and other guidelines that are related to LCDs.

Deprecations

There are no deprecations in this release.