Provider pricing

Use the existing rate resource with provider_type; there is no separate provider-rate endpoint.

GET /api/v1/rates/99214?setting=non_facility&provider_type=np
Authorization: Bearer YOUR_API_KEY

Supported provider_type values: physician (default), psychologist, csw, mft, mhc, np, cns, pa, cnm, therapist, and dietitian.

Non-physician adjustments currently require qp_status=non_qp, no modifier, and participating pricing. Unsupported combinations return 422 invalid_parameters rather than silently ignoring an option.

Physician participation is a separate participation parameter: participating (default) or non_participating. Non-participating estimates currently require non_qp. QP status describes the APM schedule; it does not describe Medicare participation.

The ordinary rate response adds provider_type, participation, and adjustment when either option is supplied. The adjustment has multiplier, source_url, and nullable note. amount is the adjusted allowed amount in cents. For non-participating physicians, limiting_charge is also returned in cents or null.

Eligibility depends on the code, setting and service date. A non-billable combination returns amount: null, unavailable_reason: not_billable, and a reason in adjustment.note. An unsupported billing condition returns unsupported. The breakdown, when requested, remains the base physician calculation before the provider adjustment.

These are supported single-service estimates, not claim adjudication or a determination of individual clinician eligibility. Review adjustment notes and source rules. Therapy-assistant reductions and interactions between non-physician discounts and multi-service therapy reductions are not applied. Use therapy estimates for the supported therapy MPPR workflow.