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Claims Repricing API  ·  Free Tier Available

Medicare Claims
Repricing API

Vendor-neutral pricing engine supporting RBRVS, OPPS, and MS-DRG fee schedules.
Get started free with 1,000 claims/month. No credit card required.

Get Free API Key → View API Docs →
How It Works

Three steps to
instant repricing.

Submit a claim, get back Medicare-accurate pricing with full RVU, APC, and DRG breakdowns.

1

Sign Up Free

Create an account and get your API key instantly. No credit card, no sales call, no contract.

2

Submit Claims

POST claims to the REST API with procedure codes, modifiers, and billed amounts.

POST /pricing/api/v1/reprice
3

Get Instant Pricing

Receive Medicare-accurate pricing with full RVU/APC/DRG breakdown in milliseconds.

Capabilities

Complete Medicare
fee schedule coverage.

One API for professional, outpatient, and inpatient repricing with full modifier support.

Medicare RBRVS (Professional)

Work RVU, Practice Expense RVU, and Malpractice RVU with geographic GPCI adjustments. Conversion factor pricing for every CPT code in the physician fee schedule.

Medicare OPPS (Outpatient)

APC-based payment rates with status indicator logic. Comprehensive C-APC, composite APC, and pass-through payment support for hospital outpatient claims.

Medicare MS-DRG (Inpatient)

DRG weight multiplied by facility base rate with wage index adjustments. Supports all CMS MS-DRG groupings for inpatient prospective payment.

Full Modifier Support

Modifier 50 (bilateral), 52 (reduced services), 80/81/82 (assistant surgeon), 62 (co-surgeon), and MPPR (multiple procedure payment reduction) logic built in.

Pricing

Start free.
Scale when ready.

No credit card required for the free tier. Upgrade or downgrade anytime.

Free
$0/mo
1,000 claims/month
  • All fee schedules (RBRVS, OPPS, MS-DRG)
  • Full modifier support
  • REST API access
  • Community support
Get Started Free
Starter
$49/mo
10,000 claims/month
  • Everything in Free
  • Batch repricing endpoint
  • Webhook notifications
  • Email support
Get Started
Professional
$199/mo
100,000 claims/month
  • Everything in Starter
  • Custom fee schedules
  • Priority API routing
  • Priority support (SLA)
Get Started
Enterprise
Custom
Unlimited claims
  • Everything in Professional
  • Dedicated infrastructure
  • Custom integrations
  • Dedicated account team
Contact Sales
Get Started

Get your free
API key now.

No credit card required. Start repricing claims in minutes.

Quick Start

Reprice a claim
in one request.

cURL 
curl -X POST https://api.cloudhealthoffice.com/pricing/api/v1/reprice \
  -H "X-API-Key: cho_your_api_key" \
  -H "Content-Type: application/json" \
  -d '{
    "feeScheduleId": "MEDICARE_RBRVS_2025",
    "claimType": "Professional",
    "lines": [
      {
        "lineNumber": 1,
        "procedureCode": "99213",
        "units": 1,
        "billedAmount": 150.00
      }
    ]
  }'

Ready to integrate
Medicare repricing?

Get started with the free tier or talk to our team about enterprise integration.

Get Free API Key → API Documentation →

Questions? Email sales@cloudhealthoffice.com