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GET
/
v1
/
policies
/
{policy_id}
Get Policy
curl --request GET \
  --url https://api-sandbox.penelope.health/v1/policies/{policy_id} \
  --header 'x-api-key: <api-key>'
{
  "policy_id": "uhc/MP.002.28/2026-01-01",
  "policy_number": "MP.002.28",
  "title": "Brow Ptosis and Eyelid Repair",
  "effective_from_date": "2026-01-01",
  "file_url": "https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/brow-ptosis-and-eyelid-repair.pdf",
  "listing_url": "https://www.uhcprovider.com/en/policies-protocols/comm-medical-drug-policies/comm-medical-drug-policies.html",
  "summary": "This policy covers blepharoplasty and brow lift procedures when medically necessary for functional impairment...",
  "score": 4.26,
  "applicability": [
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "commercial",
        "individual_aca"
      ]
    }
  ],
  "code_groups": [
    {
      "code_system": "CPT",
      "relationship": "COVERS",
      "category": "Brow Ptosis Procedures",
      "codes": [
        "15822",
        "15823"
      ],
      "descriptions": [
        "Upper eyelid blepharoplasty",
        "Repair blepharoptosis"
      ]
    }
  ],
  "criteria_text": "## Coverage Criteria\n\nBlepharoplasty is considered medically necessary when ALL of the following are met:\n- Visual field obstruction documented..."
}

Authorizations

​
x-api-key
string
header
required

Path Parameters

​
policy_id
string
required

Response

Successful Response

Single-policy detail response. Adds heavyweight fields not in list responses.

​
policy_id
string
required

Unique policy identifier

Example:

"uhc/MP.002.28/2026-01-01"

​
policy_number
string
required

Policy number assigned by the payer

Example:

"MP.002.28"

​
title
string
required

Policy title

Example:

"Brow Ptosis and Eyelid Repair"

​
effective_from_date
string<date>
required

Date the policy became effective

Example:

"2026-01-01"

​
effective_to_date
string<date> | null
required

Date the policy was superseded (null if currently active)

Example:

null

​
file_url
string
required

Original URL from which the policy file was downloaded

Example:

"https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/brow-ptosis-and-eyelid-repair.pdf"

​
listing_url
string
required

URL of the listing page where the policy was found

Example:

"https://www.uhcprovider.com/en/policies-protocols/comm-medical-drug-policies/comm-medical-drug-policies.html"

​
summary
string | null
required

AI-generated policy summary

Example:

"This policy covers blepharoplasty and brow lift procedures when medically necessary for functional impairment..."

​
applicability
LobApplicability · object[]
required

Payer/LOB/geography applicability. Always present (possibly empty) on the detail response.

Example:
[
  {
    "lobs": ["commercial", "individual_aca"],
    "payer_ids": ["KMQTZ"],
    "payer_names": ["UnitedHealthcare"]
  }
]
​
code_groups
PolicyCodeGroup · object[]
required

Codes referenced by this policy, grouped by system and relationship. Always present (possibly empty) on the detail response.

Example:
[
  {
    "category": "Brow Ptosis Procedures",
    "code_system": "CPT",
    "codes": ["15822", "15823"],
    "descriptions": [
      "Upper eyelid blepharoplasty",
      "Repair blepharoptosis"
    ],
    "relationship": "COVERS"
  }
]
​
criteria_text
string | null
required

Concatenated markdown of coverage criteria sections extracted from the policy document. Null if the criteria extractor has not yet run on this policy.

Example:

"## Coverage Criteria\n\nBlepharoplasty is considered medically necessary when ALL of the following are met:\n- Visual field obstruction documented..."

​
score
number | null

Full-text search relevance score (only present when using q filter)

Example:

4.26