Core Endpoints

Medicare Fee Schedules

Access Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), and Inpatient Prospective Payment System (IPPS) rates by locality and provider type.

Get MPFS Rate

Look up the Medicare Physician Fee Schedule rate for a specific code and locality.

GET/v1/medicare/mpfs/{code}

curl -X GET "https://api.medref.io/v1/medicare/mpfs/99213?locality=01&modifier=&facility=false" \
  -H "Authorization: Bearer YOUR_API_KEY"

Response

{
  "code": "99213",
  "locality": "01",
  "locality_name": "Manhattan, NY",
  "year": 2024,
  "facility": false,
  "rvu": {
    "work": 1.30,
    "practice_expense_facility": 0.99,
    "practice_expense_nonfacility": 1.46,
    "malpractice": 0.10,
    "total_facility": 2.39,
    "total_nonfacility": 2.86
  },
  "gpci": {
    "work": 1.094,
    "practice_expense": 1.281,
    "malpractice": 0.720
  },
  "payment": {
    "facility": 85.75,
    "nonfacility": 102.61,
    "conversion_factor": 32.74
  },
  "status_indicator": "A",
  "global_days": "XXX",
  "effective_date": "2024-01-01"
}

Query Parameters

Parameter	Type	Description
locality	string	MAC locality code (e.g., 01, 99)
modifier	string	CPT modifier (e.g., 26, TC)
facility	boolean	Facility vs non-facility rate
year	integer	Fee schedule year (default: current)

OPPS Rates

Hospital Outpatient Prospective Payment System rates for facility billing.

GET/v1/medicare/opps/{code}

curl -X GET "https://api.medref.io/v1/medicare/opps/27447" \
  -H "Authorization: Bearer YOUR_API_KEY"

// Response includes APC, status indicator, and payment rates

List Localities

Get all Medicare Administrative Contractor (MAC) localities with their GPCI values.

GET/v1/medicare/localities

curl -X GET "https://api.medref.io/v1/medicare/localities?state=NY" \
  -H "Authorization: Bearer YOUR_API_KEY"