Public domain -- Verbatim ingests and serves it
Copyrighted -- cited, never served
Regulatory
"What are the rules?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| Federal Register -- proposed + final rules | CMS / NARA | Where rules are made and changed; annual payment rules live here | Carried |
| CMS Internet-Only Manuals -- Pub 100-02, 100-04, 100-08 | CMS | The operational rulebook billers work from | Carried |
| Transmittals / Change Requests | CMS | The diffs -- what changed in the manuals and when | Carried |
| MLN articles + booklets | CMS | Plain-language education that translates the rules | Carried |
Coding & billing
"How do I describe the encounter?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| NCCI -- PTP edits (3.13M pairs) + MUEs (33,354 limits) + Policy Manual | CMS | Which codes can or cannot combine; per-line unit limits, and the rationale | Carried |
| HCPCS Level II -- 16,733 codes + descriptors | CMS | Supplies, drugs, and DME beyond CPT | Carried |
| ICD-10-CM Official Coding Guidelines + ICD-10-PCS | CDC/NCHS + CMS | Why the patient was seen; inpatient procedures | Carried |
| Place of Service (POS) -- 52 codes + descriptors | CMS | Where the service happened | Carried |
| Institutional code facts -- bill type, revenue, condition, value, occurrence (3,301 Medicare facts) | CMS (Pub 100-04) | How an institutional claim is structured, from CMS's own instructions | Carried |
| CPT codes + descriptors (Level I) | AMA | Physician / outpatient procedures | Cited only |
| NUBC curated UB-04 master code tables | NUBC | The proprietary institutional master lists | Cited only |
Individual code facts are not copyrightable; the curated tables and the proprietary descriptor text are. Verbatim builds the operational "how to bill" layer from CMS's own public words, and points to the licensed descriptor sets your encoder already holds.
Coverage
"Will it be paid at all?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| NCDs -- National Coverage Determinations | CMS | Nationwide coverage rules | Carried |
| LCDs + Local Coverage Articles (NY jurisdiction) | MACs | Regional coverage and the exact diagnoses that support medical necessity | Carried -- NY |
Local coverage is carried for the New York jurisdiction today. National coverage (NCDs) is nationwide. All-jurisdiction local coverage is on the roadmap, not yet in corpus.
Payment
"How much, and on what basis?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| MPFS -- Physician Fee Schedule + RVUs / indicators | CMS | Pricing plus global periods, bilateral, and assistant-surgery flags | Carried |
| OPPS / APC -- Addendum A + B | CMS | Hospital outpatient pricing | Carried |
| IPPS / MS-DRG | CMS | Inpatient pricing | Carried |
| ASC payment | CMS | Ambulatory surgery center pricing | Carried |
| DMEPOS fee schedule | CMS | Durable medical equipment pricing | Carried |
| Clinical Lab Fee Schedule (CLFS) | CMS | Lab pricing | Carried |
Adjudication & remittance
"What happened to the claim?"| Source | Publisher | What it answers | Status |
|---|---|---|---|
| Claims-processing rules -- Pub 100-04, inside the manual corpus | CMS | How claim lines are adjudicated | Carried |
| The appeals pathway -- redetermination → reconsideration → ALJ | CMS | The recourse path when a claim is denied | Carried |
| CARC / RARC maintained denial-reason lists | X12 | The canonical code table that explains a paid, reduced, or denied line | Cited only |
The "what do I do about this denial" knowledge -- the claims-processing rules and the appeal path -- is public and in corpus. Only the canonical denial-reason code table sits behind a license, so it is pointed to, never redistributed.
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