> ## Documentation Index > Fetch the complete documentation index at: https://docs.penelope.health/llms.txt > Use this file to discover all available pages before exploring further. # Get Policy > Get a single policy by policy_id with current applicability, code groups, and criteria text. ## OpenAPI ````yaml /api-reference/openapi.json get /v1/policies/{policy_id} openapi: 3.1.0 info: title: Penelope Health API description: REST API for querying the Penelope Health knowledge graph. version: 1.0.0 servers: - url: https://api-sandbox.penelope.health description: Sandbox - url: https://api.penelope.health description: Production security: [] paths: /v1/policies/{policy_id}: get: summary: Get Policy description: >- Get a single policy by policy_id with current applicability, code groups, and criteria text. operationId: get_policy_v1_policies__policy_id__get parameters: - name: policy_id in: path required: true schema: type: string title: Policy Id description: Unique policy identifier examples: - uhc/MP.002/2026-01-01 description: Unique policy identifier responses: '200': description: Successful Response content: application/json: schema: $ref: '#/components/schemas/PolicyDetailResult' example: 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' 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 - individual_aca 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 See Benefit Considerations **Note:** The InterQual® criteria below only applies to persons 18 years of age and older. **Brow ptosis repair and repair of the eyelid are considered reconstructive and medically necessary in certain circumstances.** For medical necessity clinica... '422': description: Validation Error content: application/json: schema: $ref: '#/components/schemas/HTTPValidationError' security: - APIKeyHeader: [] components: schemas: PolicyDetailResult: properties: policy_id: type: string title: Policy Id description: Unique policy identifier examples: - uhc/MP.002/2026-01-01 policy_number: type: string title: Policy Number description: Policy number assigned by the payer examples: - MP.002.28 title: type: string title: Title description: Policy title examples: - Brow Ptosis and Eyelid Repair effective_from_date: type: string format: date title: Effective From Date description: First day the policy is in effect (inclusive) examples: - '2026-01-01' effective_to_date: anyOf: - type: string format: date - type: 'null' title: Effective To Date description: >- First date the policy is no longer in effect (exclusive end); null if currently active examples: - null file_url: type: string title: File Url description: Original URL from which the policy file was downloaded examples: - >- https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/brow-ptosis-and-eyelid-repair.pdf file_type: type: string enum: - pdf - html - md title: File Type description: >- Format of the stored copy of the policy document, downloadable via the download-url endpoint. examples: - pdf listing_url: type: string title: Listing Url description: URL of the listing page where the policy was found examples: - >- https://www.uhcprovider.com/en/policies-protocols/comm-medical-drug-policies/comm-medical-drug-policies.html summary: anyOf: - type: string - type: 'null' title: Summary description: AI-generated policy summary examples: - >- This policy covers blepharoplasty and brow lift procedures when medically necessary for functional impairment... score: anyOf: - type: number - type: 'null' title: Score description: >- 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). examples: - 4.26 applicability: items: $ref: '#/components/schemas/LobApplicability' type: array title: Applicability description: >- Current payer/LOB/geography applicability. Always present (possibly empty) on the detail response. examples: - - lobs: - commercial - individual_aca payer_ids: - KMQTZ payer_names: - UnitedHealthcare code_groups: items: $ref: '#/components/schemas/PolicyCodeGroup' type: array title: Code Groups description: >- Codes referenced by this policy, grouped by system and relationship. Always present (possibly empty) on the detail response. examples: - - category: Brow Ptosis Procedures code_system: CPT codes: - '15822' - '15823' descriptions: - Upper eyelid blepharoplasty - Repair blepharoptosis relationship: COVERS criteria_text: anyOf: - type: string - type: 'null' title: Criteria Text description: >- Concatenated markdown of coverage criteria sections extracted from the policy document. Null if the criteria extractor has not yet run on this policy. examples: - >- ## Coverage Criteria Blepharoplasty is considered medically necessary when ALL of the following are met: - Visual field obstruction documented... type: object required: - policy_id - policy_number - title - effective_from_date - effective_to_date - file_url - file_type - listing_url - summary - applicability - code_groups - criteria_text title: PolicyDetailResult description: >- Single-policy detail response. Adds heavyweight fields not in list responses. HTTPValidationError: properties: detail: items: $ref: '#/components/schemas/ValidationError' type: array title: Detail type: object title: HTTPValidationError LobApplicability: properties: payer_ids: items: type: string type: array title: Payer Ids description: Payer IDs that share this coverage scope examples: - - KMQTZ payer_names: items: type: string type: array title: Payer Names description: Display names of payers examples: - - UnitedHealthcare lobs: items: $ref: '#/components/schemas/LobCategory' type: array title: Lobs description: LOB categories this scope applies to examples: - - commercial - individual_aca state: anyOf: - type: string - type: 'null' title: State description: US state for this scope (null if nationwide) examples: - null type: object required: - payer_ids - payer_names - lobs - state title: LobApplicability description: >- Single applicability scope — Cartesian product of payers × LOBs × geography. PolicyCodeGroup: properties: code_system: type: string enum: - CPT - CPT_MODIFIER - HCPCS - HCPCS_MODIFIER - ICD10CM title: Code System description: Code system type examples: - CPT relationship: type: string enum: - COVERS - DOES_NOT_COVER - REFERENCES title: Relationship description: Relationship type between policy and codes examples: - COVERS category: anyOf: - type: string - type: 'null' title: Category description: Semantic category from policy, if provided examples: - Brow Ptosis Procedures codes: items: type: string type: array title: Codes description: List of codes in this group examples: - - '19318' - '19319' - '67900' descriptions: items: type: string type: array title: Descriptions description: Human-readable descriptions, aligned 1:1 with codes list examples: - - Upper eyelid blepharoplasty - Repair blepharoptosis type: object required: - code_system - relationship - category - codes title: PolicyCodeGroup description: Group of codes with same system, relationship, and category. ValidationError: properties: loc: items: anyOf: - type: string - type: integer type: array title: Location msg: type: string title: Message type: type: string title: Error Type input: title: Input ctx: type: object title: Context type: object required: - loc - msg - type title: ValidationError LobCategory: type: string enum: - commercial - medicare_part_a - medicare_part_b - medicare_advantage - medicare_part_d - medicaid - individual_aca title: LobCategory description: Line-of-business categories. securitySchemes: APIKeyHeader: type: apiKey in: header name: x-api-key ````