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Claims Repricing API  ·  Access by Request

Medicare Claims
Repricing API

Vendor-neutral pricing engine supporting RBRVS, OPPS, and MS-DRG fee schedules.
Request access for pilots and local evaluation while the public API endpoint is being prepared.

Request API Access → View API Docs →
How It Works

Three steps to
your own repricing API.

Deploy the source-available service locally or in your cloud, then submit claims for RVU, APC, and DRG breakdowns.

1

Request Access

Use the docs and local deployment path today; request hosted API access when you are ready for a guided pilot.

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 locally.
Scale when ready.

The pricing engine can be evaluated locally today. Hosted API access is available by request for pilots.

Self-hosted Evaluation
$0/mo
Free for non-production use
  • All fee schedules (RBRVS, OPPS, MS-DRG)
  • Full modifier support
  • Local REST API deployment
  • Source-available evaluation path
Request API Access
Need More Capacity?
See Plans
Higher-volume & custom integrations
  • Self-serve subscription tiers above the free tier
  • Usage-scaled pricing for higher claim volumes
  • Custom fee schedules & priority routing
  • Priority support and SLA options
Full Pricing → Contact Sales
Get Started

Request
API access.

The public API host is not currently deployed. Contact us for pilot access or run the pricing engine locally.

Quick Start

Reprice a claim
in one request.

cURL 
curl -X POST https://api.your-domain.example/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?

Start with local evaluation or talk to our team about hosted pilot access.

Request API Access → API Documentation →

Questions? Email sales@cloudhealthoffice.com