localis
API key

Describe a service in plain words, or type a CPT/HCPCS code.

Rates API

API v1

Price one code, a batch of codes, or a year-by-year series against the Medicare Physician Fee Schedule.

Single rate lookup

Price one HCPCS/CPT code for a locality (or the national amount, if none is given) and setting.

GET /v1/rates/{hcpcs}
locality
string
Composite key "{mac}-{code}", e.g. "01182-18"—see /v1/localities.
locality_id
integer
Numeric locality ID, as an alternative to the composite key.
zip
string
A ZIP resolves the locality via the versioned crosswalk. Combined with an explicit locality, it must agree (422 otherwise). An ambiguous ZIP is rejected—see GET /v1/zip/{zip} for the same ZIP resolved on its own, which answers ambiguous ZIPs instead of erroring.
setting
facility|non_facility
Which practice-expense RVU to use. Default non_facility.
modifier
string
Up to 2 characters, e.g. "26".
sequestration
boolean
Apply the ~2% sequestration reduction after the formula. Default false.
time_minutes
number
Anesthesia only: raw minutes, to compute a real anesthesia amount for status J codes.
qpp
boolean
Physician QPP conversion-factor split (CY2026+).
request 
curl "https://localishealth.com/v1/rates/99213?locality=01182-18&setting=non_facility" \
  -H "Authorization: Bearer sk_live_…"
response—200 
{
  "hcpcs": "99213",
  "modifier": null,
  "setting": "non_facility",
  "payable": true,
  "amount": 97.20,
  "gross_amount": 97.20,
  "status_code": "A",
  "sequestration_applied": false,
  "conversion_factor": 33.29,
  "qpp": false,
  "citations": { "sources": { "rvu": { … }, "gpci": { … } }, "calculation": { … } },
  "release": { "schedule": "pfs", "year": 2026, "quarter": "A", "revision": 1 },
  "locality": { "mac": "01182", "code": "18", "state": "CA", "name": "Los Angeles, CA" }
}

See Citations & provenance for the full shape of citations. A non-payable result omits amount/gross_amount and returns reason instead. Carrier-priced status-C results also include mac_fee_lookup_hint with reason: carrier_priced and the matching /v1/mac-fees/{hcpcs} path.

Lab codes priced under the CLFS

A status-X code the PFS excludes but the Clinical Laboratory Fee Schedule prices (80053, 85025, 36415 and the rest of the lab family) is answered with its CLFS rate: fee_schedule: "clfs", the PFS status_code that routed it, and a clfs block naming the CLFS release, row and effective date the amount came from. Every other result carries fee_schedule: "pfs".

The top-level release stays the PFS release that resolved the status; the amount's source is clfs.release. The CLFS sets one national rate, so locality and setting don't change the amount, though both are still echoed. The date of service is as_of, the first day of the requested year/quarter, or today. Each code's row is the latest one effective on or before that date. If CMS has no file for that quarter, an earlier file from the same year answers, with a note. A prior year's file never does. Sequestration applies after the CLFS rate, as it does for a PFS amount. modifier=QW reads the CLIA-waived row. An indicator L code is priced by each MAC, so it returns payable: false with a reason, never a $0.

GET /v1/rates/80053
response—200 
{
  "hcpcs": "80053",
  "modifier": null,
  "setting": "non_facility",
  "payable": true,
  "amount": 10.56,
  "gross_amount": 10.56,
  "status_code": "X",
  "sequestration_applied": false,
  "fee_schedule": "clfs",
  "clfs": {
    "indicator": "N",
    "effective_date": "2026-01-01",
    "release": { "schedule": "clfs", "year": 2026, "quarter": "C", "revision": 1 },
    "basis": "The CLFS sets one national rate per code, with no locality adjustment and no facility/office split. …",
    "qw": { "rate": 10.56, "effective_date": "2026-01-01", "differs_from_base": false }
  },
  "citations": { "sources": { "rvu": { … }, "clfs": { … } }, "calculation": { "formula": "amount = clfs_rate", … } },
  "release": { "schedule": "pfs", "year": 2026, "quarter": "C", "revision": 1 },
  "locality": null
}

Bulk rate lookup

Price up to 500 codes in one request against a shared locality/setting/release context. A code that can't be priced doesn't fail the batch—it comes back with payable: false and a reason.

POST /v1/rates/bulk
codes
array—required
Up to 500 entries. Each is a string ("99213", "71046-26") or an object { code, modifier?, time_minutes?, qpp? } for per-line anesthesia claims.
locality / locality_id / zip
string / integer / string
Same as the single lookup—shared across every code in the batch.
setting, sequestration, year, quarter, as_of
Same as the single lookup—shared across every code in the batch.
request 
curl -X POST https://localishealth.com/v1/rates/bulk \
  -H "Authorization: Bearer sk_live_…" \
  -H "Content-Type: application/json" \
  -d '{"codes": ["99213", "99214-26"], "locality": "01182-18"}'
response—200 
{
  "release": { "schedule": "pfs", "year": 2026, "quarter": "A", "revision": 1 },
  "locality": { "mac": "01182", "code": "18", "state": "CA", "name": "Los Angeles, CA" },
  "setting": "non_facility",
  "sequestration_requested": false,
  "count": 2,
  "results": [
    { "hcpcs": "99213", "modifier": null, "amount": 97.20, "payable": true, … },
    { "hcpcs": "99214", "modifier": "26", "amount": 135.61, "payable": true, … }
  ]
}

Rate history

What one code paid over time, one point per calendar year, priced from that year's earliest published quarter. An explicit locality stays fixed; a ZIP follows the locality assigned by each year's crosswalk, and every point echoes both the release and locality that answered it. A year you want in quarterly detail can be re-requested from the single lookup with year and quarter.

Years the code wasn't separately payable stay in the series carrying their status and a reason rather than a $0—a code that was carrier-priced until CY2019 reads as exactly that, and change_from_previous compares against the last payable year rather than treating the gap as zero.

A lab code's points are priced from the CLFS the same way as a single lookup. Each point carries fee_schedule, and a CLFS-priced point adds clfs_release, the CLFS file the amount came from. CLFS coverage starts in 2018, when PAMA introduced single national rates, so earlier years show the PFS status alone.

GET /v1/rates/{hcpcs}/history
locality / locality_id
string / integer
Same as the single lookup and held constant across every year in the series.
zip
string
Resolved against each year's versioned crosswalk. If the ZIP moved between payment localities, locality_varies is true and each history point identifies the locality that priced it.
setting, modifier, sequestration, qpp
Same as the single lookup—also held constant across the series.
from_year
integer
First calendar year to include. Open-ended results are capped to the most recent 20 available years.
to_year
integer
Last calendar year to include. Omit for the most recent. A closed from_year/to_year window may span at most 20 years and must not run backwards (422).
request 
curl "https://localishealth.com/v1/rates/99213/history?locality=01182-18&from_year=2024" \
  -H "Authorization: Bearer sk_live_…"
response—200 
{
  "hcpcs": "99213",
  "setting": "non_facility",
  "locality": { "mac": "01182", "code": "18", "state": "CA", "name": "Los Angeles, CA" },
  "locality_varies": false,
  "basis": "One point per calendar year, priced from that year's earliest published quarter.",
  "count": 3,
  "history": [
    { "year": 2024, "release": { "year": 2024, "quarter": "A", … },
      "locality": { "mac": "01182", "code": "18", … }, "payable": true, "amount": 94.55, … },
    { "year": 2025, "release": { "year": 2025, "quarter": "A", … }, "payable": true, "amount": 96.10,
      "change_from_previous": { "amount": 1.55, "percent": 1.64 } },
    { "year": 2026, "release": { "year": 2026, "quarter": "A", … }, "payable": true, "amount": 97.20,
      "change_from_previous": { "amount": 1.10, "percent": 1.14 } }
  ]
}

One request is one rate computation per year, so it costs one rate-limit unit per year in the window (capped at 20) rather than a flat unit per call. A closed from_year/to_year window over 20 years is rejected with 422; an open-ended request returns the most recent 20 available points.

RVU rows

The raw PPRRVU file row(s) behind a rate answer—work/PE/malpractice RVUs, status code, and every payment-policy indicator (global days, bilateral/assistant/co-surgeon, PC/TC split) for one code, every modifier variant included. Reach for this when you need the RVU inputs themselves to reproduce or audit a calculation, not just the priced result from the rate endpoint.

The PPRRVU file's DESCRIPTION column is AMA-copyrighted and is never included in this response—every other column is.

GET /v1/rvu/{hcpcs}
year, quarter, as_of
Answer from a specific PFS release instead of the latest.
request 
curl https://localishealth.com/v1/rvu/99213 \
  -H "Authorization: Bearer sk_live_…"
response—200 
{
  "hcpcs": "99213",
  "release": { "schedule": "pfs", "year": 2026, "quarter": "A", "revision": 1 },
  "source": { "dataset": "rvu", "file": "PPRRVU2026_Jan_nonQPP.csv", "sha256": "…", "row_count": 11762 },
  "count": 1,
  "rows": [
    {
      "hcpcs": "99213", "modifier": null, "status_code": "A",
      "work_rvu": 1.30, "pe_rvu_nonfacility": 1.46, "pe_rvu_facility": 0.33, "mp_rvu": 0.09,
      "total_nonfacility": 2.85, "total_facility": 1.72,
      "pctc_indicator": "9", "global_days": "XXX",
      "multiple_proc_indicator": "0", "bilateral_surg_indicator": "0",
      "assistant_surg_indicator": "0", "co_surg_indicator": "0", "team_surg_indicator": "0",
      "endo_base_code": null, "diag_imaging_family": null
    }
  ]
}

A code with -26/-TC component pricing comes back as multiple rows, one per modifier, sorted with the base (no-modifier) row first. A code absent from the release returns 404.

Bulk RVU rows

The same raw RVU rows as the single lookup, for up to 500 codes against one shared release. A code with no RVU row doesn't fail the batch—it comes back with count: 0 and an empty rows array.

POST /v1/rvu/bulk
codes
array—required
Up to 500 HCPCS codes. Each entry is a 5-character string, e.g. "99213".
year, quarter, as_of
Same as the single lookup, shared across every code in the batch.
request 
curl -X POST https://localishealth.com/v1/rvu/bulk \
  -H "Authorization: Bearer sk_live_…" \
  -H "Content-Type: application/json" \
  -d '{"codes": ["99213", "99214"]}'
response—200 
{
  "release": { "schedule": "pfs", "year": 2026, "quarter": "A", "revision": 1 },
  "source": { "dataset": "rvu", "file": "PPRRVU2026_Jan_nonQPP.csv", "sha256": "…", "row_count": 11762 },
  "count": 2,
  "results": [
    { "hcpcs": "99213", "count": 1, "rows": [ { … } ] },
    { "hcpcs": "99214", "count": 1, "rows": [ { … } ] }
  ]
}