Get Policy

curl --request GET \
  --url https://api-sandbox.penelope.health/v1/policies/{policy_id} \
  --header 'x-api-key: <api-key>'

const options = {method: 'GET', headers: {'x-api-key': '<api-key>'}};

fetch('https://api-sandbox.penelope.health/v1/policies/{policy_id}', options)
  .then(res => res.json())
  .then(res => console.log(res))
  .catch(err => console.error(err));

<?php

$curl = curl_init();

curl_setopt_array($curl, [
  CURLOPT_URL => "https://api-sandbox.penelope.health/v1/policies/{policy_id}",
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => "",
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 30,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => "GET",
  CURLOPT_HTTPHEADER => [
    "x-api-key: <api-key>"
  ],
]);

$response = curl_exec($curl);
$err = curl_error($curl);

curl_close($curl);

if ($err) {
  echo "cURL Error #:" . $err;
} else {
  echo $response;
}

package main

import (
	"fmt"
	"net/http"
	"io"
)

func main() {

	url := "https://api-sandbox.penelope.health/v1/policies/{policy_id}"

	req, _ := http.NewRequest("GET", url, nil)

	req.Header.Add("x-api-key", "<api-key>")

	res, _ := http.DefaultClient.Do(req)

	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)

	fmt.Println(string(body))

}

require 'uri'
require 'net/http'

url = URI("https://api-sandbox.penelope.health/v1/policies/{policy_id}")

http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true

request = Net::HTTP::Get.new(url)
request["x-api-key"] = '<api-key>'

response = http.request(request)
puts response.read_body

{
  "policy_id": "uhc/MP.002/2026-01-01",
  "policy_number": "MP.002.28",
  "title": "Brow Ptosis and Eyelid Repair",
  "effective_from_date": "2026-01-01",
  "effective_to_date": "2026-08-01",
  "file_url": "https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/brow-ptosis-eyelid-repair.pdf",
  "file_type": "pdf",
  "listing_url": "https://www.uhcprovider.com/en/policies-protocols/commercial-policies/commercial-medical-drug-policies.html",
  "summary": "This UnitedHealthcare medical policy addresses reconstructive indications and cosmetic exclusions for brow ptosis and eyelid repair procedures, focusing on functional restoration of eyelid/brow anatomy and ocular surface protection. It covers diagnostic and procedural criteria for blepharoplasty, pt...",
  "applicability": [
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "commercial"
      ]
    },
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "individual_aca"
      ],
      "state": "AL"
    },
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "individual_aca"
      ],
      "state": "AZ"
    }
  ],
  "code_groups": [
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Blepharoplasty (Lower and Upper Eyelid)",
      "codes": [
        "15820",
        "15821",
        "15822",
        "15823"
      ],
      "descriptions": [
        "BLEPHAROPLASTY LOWER EYELID",
        "BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD",
        "BLEPHAROPLASTY UPPER EYELID",
        "BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Brow Ptosis Repair",
      "codes": [
        "67900"
      ],
      "descriptions": [
        "REPAIR BROW PTOSIS"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Canthoplasty/Canthopexy",
      "codes": [
        "21280",
        "21282",
        "67950"
      ],
      "descriptions": [
        "MEDIAL CANTHOPEXY SEPARATE PROCEDURE",
        "LATERAL CANTHOPEXY",
        "CANTHOPLASTY"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Ectropion and Entropion",
      "codes": [
        "67914",
        "67915",
        "67916",
        "67917",
        "67921",
        "67922",
        "67923",
        "67924"
      ],
      "descriptions": [
        "REPAIR ECTROPION SUTURE",
        "REPAIR ECTROPION THERMOCAUTERIZATION",
        "REPAIR ECTROPION EXCISION TARSAL WEDGE",
        "REPAIR ECTROPION EXTENSIVE",
        "REPAIR ENTROPION SUTURE",
        "REPAIR ENTROPION THERMOCAUTERIZATION",
        "REPAIR ENTROPION EXCISION TARSAL WEDGE",
        "REPAIR ENTROPION EXTENSIVE"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Eyelid Excision/Repair; Floppy Eyelid Syndrome",
      "codes": [
        "67961",
        "67966"
      ],
      "descriptions": [
        "EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN",
        "EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Lagophthalmos",
      "codes": [
        "67912"
      ],
      "descriptions": [
        "CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Lid Retraction",
      "codes": [
        "67911"
      ],
      "descriptions": [
        "CORRECTION LID RETRACTION"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Upper Eyelid Blepharoptosis Repair",
      "codes": [
        "67901",
        "67902",
        "67903",
        "67904",
        "67906",
        "67908",
        "67909"
      ],
      "descriptions": [
        "RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",
        "RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",
        "RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",
        "RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",
        "RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING",
        "RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ",
        "REDUCTION OVERCORRECTION PTOSIS"
      ]
    }
  ],
  "criteria_text": "## Coverage Rationale\n\nSee Benefit Considerations\n\n**Note:** The InterQual® criteria below only applies to persons 18 years of age and older.\n\n**Brow ptosis repair and repair of the eyelid are considered reconstructive and medically necessary in certain circumstances.** For medical necessity clinica..."
}

{
  "detail": [
    {
      "loc": [
        "<string>"
      ],
      "msg": "<string>",
      "type": "<string>",
      "input": "<unknown>",
      "ctx": {}
    }
  ]
}

GET

policies

{policy_id}

Get Policy

curl --request GET \
  --url https://api-sandbox.penelope.health/v1/policies/{policy_id} \
  --header 'x-api-key: <api-key>'

const options = {method: 'GET', headers: {'x-api-key': '<api-key>'}};

fetch('https://api-sandbox.penelope.health/v1/policies/{policy_id}', options)
  .then(res => res.json())
  .then(res => console.log(res))
  .catch(err => console.error(err));

<?php

$curl = curl_init();

curl_setopt_array($curl, [
  CURLOPT_URL => "https://api-sandbox.penelope.health/v1/policies/{policy_id}",
  CURLOPT_RETURNTRANSFER => true,
  CURLOPT_ENCODING => "",
  CURLOPT_MAXREDIRS => 10,
  CURLOPT_TIMEOUT => 30,
  CURLOPT_HTTP_VERSION => CURL_HTTP_VERSION_1_1,
  CURLOPT_CUSTOMREQUEST => "GET",
  CURLOPT_HTTPHEADER => [
    "x-api-key: <api-key>"
  ],
]);

$response = curl_exec($curl);
$err = curl_error($curl);

curl_close($curl);

if ($err) {
  echo "cURL Error #:" . $err;
} else {
  echo $response;
}

package main

import (
	"fmt"
	"net/http"
	"io"
)

func main() {

	url := "https://api-sandbox.penelope.health/v1/policies/{policy_id}"

	req, _ := http.NewRequest("GET", url, nil)

	req.Header.Add("x-api-key", "<api-key>")

	res, _ := http.DefaultClient.Do(req)

	defer res.Body.Close()
	body, _ := io.ReadAll(res.Body)

	fmt.Println(string(body))

}

require 'uri'
require 'net/http'

url = URI("https://api-sandbox.penelope.health/v1/policies/{policy_id}")

http = Net::HTTP.new(url.host, url.port)
http.use_ssl = true

request = Net::HTTP::Get.new(url)
request["x-api-key"] = '<api-key>'

response = http.request(request)
puts response.read_body

{
  "policy_id": "uhc/MP.002/2026-01-01",
  "policy_number": "MP.002.28",
  "title": "Brow Ptosis and Eyelid Repair",
  "effective_from_date": "2026-01-01",
  "effective_to_date": "2026-08-01",
  "file_url": "https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/brow-ptosis-eyelid-repair.pdf",
  "file_type": "pdf",
  "listing_url": "https://www.uhcprovider.com/en/policies-protocols/commercial-policies/commercial-medical-drug-policies.html",
  "summary": "This UnitedHealthcare medical policy addresses reconstructive indications and cosmetic exclusions for brow ptosis and eyelid repair procedures, focusing on functional restoration of eyelid/brow anatomy and ocular surface protection. It covers diagnostic and procedural criteria for blepharoplasty, pt...",
  "applicability": [
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "commercial"
      ]
    },
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "individual_aca"
      ],
      "state": "AL"
    },
    {
      "payer_ids": [
        "KMQTZ"
      ],
      "payer_names": [
        "UnitedHealthcare"
      ],
      "lobs": [
        "individual_aca"
      ],
      "state": "AZ"
    }
  ],
  "code_groups": [
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Blepharoplasty (Lower and Upper Eyelid)",
      "codes": [
        "15820",
        "15821",
        "15822",
        "15823"
      ],
      "descriptions": [
        "BLEPHAROPLASTY LOWER EYELID",
        "BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD",
        "BLEPHAROPLASTY UPPER EYELID",
        "BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Brow Ptosis Repair",
      "codes": [
        "67900"
      ],
      "descriptions": [
        "REPAIR BROW PTOSIS"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Canthoplasty/Canthopexy",
      "codes": [
        "21280",
        "21282",
        "67950"
      ],
      "descriptions": [
        "MEDIAL CANTHOPEXY SEPARATE PROCEDURE",
        "LATERAL CANTHOPEXY",
        "CANTHOPLASTY"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Ectropion and Entropion",
      "codes": [
        "67914",
        "67915",
        "67916",
        "67917",
        "67921",
        "67922",
        "67923",
        "67924"
      ],
      "descriptions": [
        "REPAIR ECTROPION SUTURE",
        "REPAIR ECTROPION THERMOCAUTERIZATION",
        "REPAIR ECTROPION EXCISION TARSAL WEDGE",
        "REPAIR ECTROPION EXTENSIVE",
        "REPAIR ENTROPION SUTURE",
        "REPAIR ENTROPION THERMOCAUTERIZATION",
        "REPAIR ENTROPION EXCISION TARSAL WEDGE",
        "REPAIR ENTROPION EXTENSIVE"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Eyelid Excision/Repair; Floppy Eyelid Syndrome",
      "codes": [
        "67961",
        "67966"
      ],
      "descriptions": [
        "EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN",
        "EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Lagophthalmos",
      "codes": [
        "67912"
      ],
      "descriptions": [
        "CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Lid Retraction",
      "codes": [
        "67911"
      ],
      "descriptions": [
        "CORRECTION LID RETRACTION"
      ]
    },
    {
      "code_system": "CPT",
      "relationship": "REFERENCES",
      "category": "Upper Eyelid Blepharoptosis Repair",
      "codes": [
        "67901",
        "67902",
        "67903",
        "67904",
        "67906",
        "67908",
        "67909"
      ],
      "descriptions": [
        "RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL",
        "RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING",
        "RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL",
        "RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL",
        "RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING",
        "RPR BLPOS CONJUNCTIVO-TARSO-MUSC-LEVATOR RESCJ",
        "REDUCTION OVERCORRECTION PTOSIS"
      ]
    }
  ],
  "criteria_text": "## Coverage Rationale\n\nSee Benefit Considerations\n\n**Note:** The InterQual® criteria below only applies to persons 18 years of age and older.\n\n**Brow ptosis repair and repair of the eyelid are considered reconstructive and medically necessary in certain circumstances.** For medical necessity clinica..."
}

{
  "detail": [
    {
      "loc": [
        "<string>"
      ],
      "msg": "<string>",
      "type": "<string>",
      "input": "<unknown>",
      "ctx": {}
    }
  ]
}

Authorizations

x-api-key

string

header

required

Path Parameters

policy_id

string

required

Unique policy identifier

Example:

"uhc/MP.002/2026-01-01"

Response

Successful Response

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

policy_id

string

required

Unique policy identifier

Example:

"uhc/MP.002/2026-01-01"

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

First day the policy is in effect (inclusive)

Example:

"2026-01-01"

effective_to_date

string<date> | null

required

First date the policy is no longer in effect (exclusive end); 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"

file_type

enum<string>

required

Format of the stored copy of the policy document, downloadable via the download-url endpoint.

Available options:

pdf,

html,

md

Example:

"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 (regardless of when they applied). Always present (possibly empty) on the detail response.

Show child attributes

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.

Show child attributes

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

Relevance score. Present when results are relevance-ranked — against q, or against the descriptions of the filtered codes. Null under non-relevance sorts, and for policies whose title/summary don't match the ranking text (those sort last).

Example:

4.26