W0new file
“Pull the Medicare-allowed amount for a CPAP, month 3 of a capped rental, for a Medicare patient in Utah, 84117, date of service January 15, 2024.”
By hand, today
CSV
NPI
ENRL_DT
TYPE
1
1043…
2019-04-02
Clinic
2
1234…
2021-08-16
DME
3
1552…
2022-11-30
DME
Medicare FFS Provider Enrollment
CSV
NPI
PECOS_DT
ELIG
1
1987…
2016-02-10
Y
PECOS: ordering physician
CSV
NPI
STATUS
TAXONOMY
1
1234…
A
332B00…
NPPES: NPI Registry
CSV
NPI
LICENSE
STATUS
1
1987…
UT-MD-8841
ACTIVE
State License Board (UT)
CSV
LASTNAME
NPI
EXCLDATE
1
SMITH
1552…
2019-06
2
DOE
1861…
2021-03
filter NPI ∈ {1234567890, 1987654321} → 0 rows
OIG Exclusion List (LEIE)
CSV
NPI
CATEGORY
ACCR
1
1234…
CPAP/RAD
Y
DMEPOS Supplier Directory
ZIP→CSV
practitioner-ptp-edits.csv4.1 MB
column1-column2.txt18 KB
README.txt3 KB
grep (E0601,A7030) → 0 rows
NCCI PTP: Practitioner v30.0
ZIP→CSV
dme-supplier-mue-table.csv0.9 MB
README.txt3 KB
E0601 → MUE 1 · MAI 2
MUE: DME Supplier table
ZIP→CSV
DMEPOS_2024Q1.csv61 MB
dme-rural-zip.csv2 MB
cell {E0601,RR} → E0601,RR,UT,NONRURAL,102.94
DMEPOS Fee Schedule 2024 Q1
CSV
ZIP,STATE,RURAL
84117,UT,N
84117,UT,N
picks the NONRURAL column
Rural ZIP Code File
CSV
lookup ZIP → CBA
84117 not in any active CBA (2021 to 2027)
84117 not in any active CBA (2021 to 2027)
Competitive Bidding ZIP File
HTML
cms.gov/medicare-coverage-database/view/lcd?id=33718&ver=49
L33718 · PAP Devices · v49
…re-evaluated no sooner than the 31st but no later than the 91st day after initiating therapy…LCD L33718: PAP Devices
HTML
cms.gov/medicare-coverage-database/view/ncd?id=240.4
NCD 240.4 · CPAP for OSA
…AHI or RDI ≥ 15, or 5 to 14 with symptoms…NCD 240.4: CPAP for OSA
HTML
cms.gov/medicare-coverage-database/view/article?id=pap
Policy Article · PAP Devices
…KX modifier: add only if all LCD criteria met…Policy Article: PAP Devices
HTML
cms.gov/medicare-coverage-database/view/article?id=55426
A55426 · Standard Documentation
…SWO: name/MBI, order date, item, qty, NPI, signature…A55426: Standard Documentation
PDF
20.3 · Capped Rental Items
…payment is monthly, not to exceed 13 months of continuous use…
…payment is monthly, not to exceed 13 months of continuous use…
CMS Pub. 100-04 · Rev. 12557
Pub 100-04 Ch.20: Capped Rental
verzi.health1 request · 1 hash · under 1 second
GET /rules · E0601 · DME · UT · as_of 2024-01-15"provider": { "supplier": { "enrolled_on_dos": true, "src": "provider_enrollment:2024Q1#3a9f…" }, "ordering": { "pecos_on_order_date": true, "src": "pecos:2024Q1#d88c…" }, "npi_valid": true, "src": "nppes:2024-01#2f70…", "licensed": true, "src": "state_license:UT:2024-01#4c1a…", "excluded": false, "src": "leie:2024-01#c07d…", "accredited": true, "src": "dmepos_supplier_dir:2024-01#91be…", "approved_by": "verzi:reviewer_01", "approved_at": "2024-01-08", "confidence": "human_reviewed" }
GET /rules · E0601 · DME · UT · as_of 2024-01-15"edits": { "ptp": { "pair": ["E0601","A7030"], "value": "no_active_edit", "src": "ncci_ptp_prac:v30.0#c21e…", "match": "none" }, "mue": { "units_max": 1, "mai": 2, "src": "ncci_mue_dme:2024Q1#40aa…" }, "approved_by": "verzi:reviewer_01", "approved_at": "2024-01-08", "confidence": "human_reviewed" }
GET /rules · E0601 · DME · UT · as_of 2024-01-15"fee": { "value": 102.94, "column": "NONRURAL", "cell": { "hcpcs": "E0601", "mod": "RR", "state": "UT" }, "src": "dmepos_fs:2024Q1#7e12…", "resolved_by": { "rurality": { "src": "rural_zip:2024Q1#b44a…", "rural": false }, "competitive_bid": { "src": "cba_zip:2021#5d0c…", "match": "none" } }, "valid": { "from": "2024-01-01", "to": "2024-03-31" }, "approved_by": "verzi:reviewer_01", "approved_at": "2024-01-08", "confidence": "human_reviewed" }
GET /rules · E0601 · DME · UT · as_of 2024-01-15"policy": { "required": { "sleep_study": { "src": "ncd:240.4#a1d2…", "span": [2318,2507] }, "reeval_31_91": { "src": "lcd:33718@v49#e41b…", "span": [4112,4209] }, "kx_modifier": { "src": "article:pap#f7c9…", "span": [1904,2071] }, "swo_6_elements": { "src": "article:55426#2b8e…", "span": [3660,3801] }, "rental_le_13": { "src": "manual:clm104c20#9c04…", "span": [61203,61258] } }, // the chart is the customer's layer, not ours "documentation_satisfied": null, "approved_by": "verzi:reviewer_01", "approved_at": "2024-01-08", "confidence": "human_reviewed" }
replayable against the source bytes. No trust in Verzi required. Replay this receipt →
Illustrative. The document names and doc-ids are real; dollars, versions, spans and hashes are placeholders. The version in force on a date is not typed. It is resolved live by the archive: GET /v1/archive/docs/lcd:33718/as-of?date=2024-01-15 (public, no key). The composed /rules response ships Q4 2026; the source archive and as-of resolution are live today.
Warranted, not cited. Calibrated, not confident.
One CPAP line, denied. On the left is what you open by hand to fight it: the actual files, in their actual formats. On the right, Verzi's answer, a warrant with the source, the pointer, the version and a hash you can replay against the bytes yourself. Same question, every payer meeting: what was true on the date of service?
Everyone rebuilds this. Nobody shares it. The public files are the card network. Verzi is the Stripe.
Move the date, and three of the four warrants resolve to a different file
HCPCSE0601 · CPAP
WhereDME · UT · 84117
Rentalmonth 3
Date of service
W1new file
W2new file
W3new file
Verified in the archive on L33718: version 48 in force 2021-09-27 to 2023-12-31; version 49 from 2024-01-01; current live version is 52. A date of service of 2024-01-15 resolves to v49. Four weeks earlier resolves to v48. The "as of" engine picks the one in force and returns its hash. It never guesses.