> ## Documentation Index
> Fetch the complete documentation index at: https://docs.morf.health/docs/llms.txt
> Use this file to discover all available pages before exploring further.

# Create Cms1500

> Documentation for the Create Cms1500 action for Healthie

![images/healthie.svg](https://mintcdn.com/morfhealth/EU2WCxuXGIUQcziR/images/healthie.svg?fit=max\&auto=format\&n=EU2WCxuXGIUQcziR\&q=85\&s=d168a24dbae69f2202ca63dd7aa2e1f3)

# Parameters

**Action** `Parameters`

**parameters**

**Patient ID** `string`

`ID`
This field maps to the destination API `patient.id` field.

**Form Answer Group ID** `string`

This field maps to the destination API `form_answer_group_id` field.

**Referring Provider First Name** `string`

This field maps to the destination API `referral_info.ref_provider_first` field.

**Referring Provider Last Name** `string`

This field maps to the destination API `referral_info.ref_provider_last` field.

**Referring Provider Qualifier** `string`

This field maps to the destination API `referral_info.ref_provider_qual` field.

**Referring Provider NPI** `string`

`PII`
This field maps to the destination API `referral_info.ref_provider_npi` field.

**Referring Provider Prior Authorization Number** `string`

`PII`
This field maps to the destination API `referral_info.prior_auth_number` field.

**Dietitian ID** `string`

`ID`
This field maps to the destination API `dietitian.id` field.

**Dietitian Qualifications** `string`

This field maps to the destination API `dietitian.qualifications` field.

**Dietitian NPI** `string`

This field maps to the destination API `dietitian.npi` field.

**Service Location ID** `string`

This field maps to the destination API `service_location_id` field.

**Organization Information ID** `string`

This field maps to the destination API `organization_info_id` field.

**Primary Insurance Policy ID** `string`

This field maps to the destination API `cms1500_policies[].policy.id` field.

**Secondary Insurance Policy ID** `string`

This field maps to the destination API `cms1500_policies[].policy.id` field.

**Client Signature On File** `bool`

This field maps to the destination API `client_sig_on_file` field.

**Insured Signature On File** `bool`

This field maps to the destination API `insured_sig_on_file` field.

**Accept Assignment** `bool`

This field maps to the destination API `accept_assignment` field.

**ICD Codes 1 ID** `string`

This field maps to the destination API `icd_codes_cms1500s[0].icd_code_id` field.

**ICD Codes 1 Active** `bool`

This field maps to the destination API `icd_codes_cms1500s[0].active` field.

**ICD Codes 1 End Date** `values.v1.Date`

This field maps to the destination API `icd_codes_cms1500s[0].end_date` field.

**ICD Codes 2 ID** `string`

This field maps to the destination API `icd_codes_cms1500s[1].icd_code_id` field.

**ICD Codes 2 Active** `bool`

This field maps to the destination API `icd_codes_cms1500s[1].active` field.

**ICD Codes 2 End Date** `values.v1.Date`

This field maps to the destination API `icd_codes_cms1500s[1].end_date` field.

**ICD Codes 3 ID** `string`

This field maps to the destination API `icd_codes_cms1500s[2].icd_code_id` field.

**ICD Codes 3 Active** `bool`

This field maps to the destination API `icd_codes_cms1500s[2].active` field.

**ICD Codes 3 End Date** `values.v1.Date`

This field maps to the destination API `icd_codes_cms1500s[2].end_date` field.

**ICD Codes 4 ID** `string`

This field maps to the destination API `icd_codes_cms1500s[3].icd_code_id` field.

**ICD Codes 4 Active** `bool`

This field maps to the destination API `icd_codes_cms1500s[3].active` field.

**ICD Codes 4 End Date** `values.v1.Date`

This field maps to the destination API `icd_codes_cms1500s[3].end_date` field.

**CPT Codes 1 Code ID** `string`

This field maps to the destination API `cpt_codes_cms1500s[0].cpt_code_id` field.

**CPT Codes 1 Units** `string`

This field maps to the destination API `cpt_codes_cms1500s[0].units` field.

**CPT Codes 1 Modifiers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[0].mod(1-4)` field.

**CPT Codes 1 Pointers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[0].pointers` field.

**CPT Codes 1 Service Date** `values.v1.Date`

This field maps to the destination API `cpt_codes_cms1200s[1].service_date` field.

**CPT Codes 2 Code ID** `string`

This field maps to the destination API `cpt_codes_cms1500s[1].cpt_code_id` field.

**CPT Codes 2 Units** `string`

This field maps to the destination API `cpt_codes_cms1500s[1].units` field.

**CPT Codes 2 Modifiers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[1].mod(1-4)` field.

**CPT Codes 2 Pointers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[1].pointers` field.

**CPT Codes 2 Service Date** `values.v1.Date`

This field maps to the destination API `cpt_codes_cms1200s[2].service_date` field.

**CPT Codes 3 Code ID** `string`

This field maps to the destination API `cpt_codes_cms1500s[2].cpt_code_id` field.

**CPT Codes 3 Units** `string`

This field maps to the destination API `cpt_codes_cms1500s[2].units` field.

**CPT Codes 3 Modifiers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[2].mod(1-4)` field.

**CPT Codes 3 Pointers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[2].pointers` field.

**CPT Codes 3 Service Date** `values.v1.Date`

This field maps to the destination API `cpt_codes_cms1300s[3].service_date` field.

**CPT Codes 4 Code ID** `string`

This field maps to the destination API `cpt_codes_cms1500s[3].cpt_code_id` field.

**CPT Codes 4 Units** `string`

This field maps to the destination API `cpt_codes_cms1500s[3].units` field.

**CPT Codes 4 Modifiers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[3].mod(1-4)` field.

**CPT Codes 4 Pointers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[3].pointers` field.

**CPT Codes 4 Service Date** `values.v1.Date`

This field maps to the destination API `cpt_codes_cms1400s[4].service_date` field.

**CPT Codes 5 Code ID** `string`

This field maps to the destination API `cpt_codes_cms1500s[4].cpt_code_id` field.

**CPT Codes 5 Units** `string`

This field maps to the destination API `cpt_codes_cms1500s[4].units` field.

**CPT Codes 5 Modifiers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[4].mod(1-4)` field.

**CPT Codes 5 Pointers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[4].pointers` field.

**CPT Codes 5 Service Date** `values.v1.Date`

This field maps to the destination API `cpt_codes_cms1500s[5].service_date` field.

**CPT Codes 6 Code ID** `string`

This field maps to the destination API `cpt_codes_cms1500s[5].cpt_code_id` field.

**CPT Codes 6 Units** `string`

This field maps to the destination API `cpt_codes_cms1500s[5].units` field.

**CPT Codes 6 Modifiers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[5].mod(1-4)` field.

**CPT Codes 6 Pointers** `[]string`

This field maps to the destination API `cpt_codes_cms1500s[5].pointers` field.

**CPT Codes 6 Service Date** `values.v1.Date`

This field maps to the destination API `cpt_codes_cms1500s[6].service_date` field.

```json Result Object Example theme={null}
{
  "$result_object_key": {
    "accept_assignment": true,
    "billing_provider_id": "PROV123",
    "client_sig_on_file": true,
    "cms1500_policies": [
      {
        "benefits": [
          {
            "coinsurance": "15",
            "copay": "50",
            "deductible_calendar_year": "2000",
            "deductible_year_to_date": "1500"
          }
        ],
        "effective_end": "2024-07-04",
        "group_num": "331256",
        "id": "202402",
        "insurance_card_back_id": "123452",
        "insurance_card_front_id": "123451",
        "insurance_plan": {
          "id": "611231",
          "name_and_id": "Blue Cross Blue Shield - 629913",
          "payer_id": "629913",
          "payer_name": "Blue Cross Blue Shield"
        },
        "insurance_type": "Medicaid",
        "notes": "Policy is active",
        "num": "1912310",
        "patient_id": "100121",
        "priority_type": "Primary",
        "updated_at": "2024-07-01T11:29:19+00:00"
      }
    ],
    "cpt_codes_cms1500s": [
      {
        "cpt_code": "99215",
        "description": "New patient office visit, 45-60 minutes",
        "display_name": "New patient office visit",
        "mod1": "25",
        "mod2": "59",
        "mod3": "12",
        "mod4": "34",
        "pointers": "1",
        "service_date": "2025-09-22",
        "units": "1"
      }
    ],
    "dietician_organization_id": "123450",
    "dietitian_email_address": "drfleming@example.com",
    "dietitian_first_name": "Alexander",
    "dietitian_id": "100070",
    "dietitian_last_name": "Fleming",
    "dietitian_organization_id": "123450",
    "icd_codes_cms1500s": [
      {
        "active": true,
        "code": "F41.1",
        "created_at": "2024-01-15T10:30:00Z",
        "display_name": "Generalized anxiety disorder",
        "end_date": "2024-12-31",
        "first_symptom_date": "2024-01-10",
        "id": "789012",
        "updated_at": "2024-01-15T10:30:00Z"
      }
    ],
    "id": "57211",
    "insured_sig_on_file": true,
    "organization_info_id": "ORG789",
    "patient": {
      "date_of_birth": "1985-03-15",
      "location": {
        "city": "San Francisco",
        "country": "USA",
        "line1": "123 Main Street",
        "line2": "Suite 100",
        "state": "CA",
        "zip": "94117"
      },
      "sex": "Male"
    },
    "patient_id": "121250",
    "referral_info": {
      "case_qualifier": "431",
      "prior_auth_number": "AUTH123456",
      "ref_provider_first": "John",
      "ref_provider_last": "Smith",
      "ref_provider_qual": "MD"
    },
    "service_location_id": "LOC456"
  }
}
```

```json Result Object Description theme={null}
{
  "$result_object_key": {
    "accept_assignment": "The provider agrees to accept assignment",
    "billing_provider_id": "The ID of the Billing Provider",
    "client_sig_on_file": "True if the client's signature is on file",
    "cms1500_policies": {
      "benefits": {
        "coinsurance": "Coinsurance percentage due",
        "copay": "Copay amount due",
        "deductible_calendar_year": "Deductible amount for the calendar year",
        "deductible_year_to_date": "Deductible amount for the year to-date"
      },
      "effective_end": "Date the policy coverage expires",
      "group_num": "Group number",
      "id": "ID for the policy",
      "insurance_card_back_id": "ID of the insurance card back image object",
      "insurance_card_front_id": "ID of the insurance card front image object",
      "insurance_plan": {
        "id": "ID of the insurance plan",
        "name_and_id": "Name of the payer and id of payer",
        "payer_id": "ID of the insurance payer",
        "payer_name": "Name of the insurance payer"
      },
      "insurance_type": "The type of insurance: `type_string`",
      "notes": "Notes about the policy",
      "num": "Policy number",
      "patient_id": "ID of the patient associated with the policy",
      "priority_type": "The priority type of insurance: `priority_type`",
      "updated_at": "Last time the Policy was updated"
    },
    "cpt_codes_cms1500s": {
      "cpt_code": "The CPT code",
      "description": "The CPT code description",
      "display_name": "The CPT display name used in labels",
      "mod1": "First modification code",
      "mod2": "Second modification code",
      "mod3": "Third modification code",
      "mod4": "Fourth modification code",
      "pointers": "Diagnostic pointers. These are used to connect Diagnosis(ICD) with appropriate Billing Item(CPT) in CMS1500 form",
      "service_date": "The service date for the specific code",
      "units": "Units for the CPT code"
    },
    "dietician_organization_id": "Organization ID for the User's (Patient's) registered dietitian",
    "dietitian_email_address": "Email address of the User's (Patient's) registered dietitian",
    "dietitian_first_name": "First name of the User's (Patient's) registered dietitian",
    "dietitian_id": "ID of the User's (Patient's) registered dietitian",
    "dietitian_last_name": "Last name of the User's (Patient's) registered dietitian",
    "dietitian_organization_id": "Organization ID for the User's (Patient's) registered dietitian",
    "icd_codes_cms1500s": {
      "active": "Active IcdCodesCms1500",
      "code": "The ICD code",
      "created_at": "Date created",
      "display_name": "Display name for the ICD code",
      "end_date": "End date",
      "first_symptom_date": "ICD codes in use for this claim",
      "id": "The unique identifier of the CMS 1500 ICD code",
      "updated_at": "Date updated"
    },
    "id": "CMS1500 object ID",
    "insured_sig_on_file": "True if the insured's signature is on file",
    "organization_info_id": "The ID of the Organization Info",
    "patient": {
      "date_of_birth": "Date of birth of user",
      "location": {
        "city": "City",
        "country": "Country",
        "line1": "First line of the address",
        "line2": "Second line of the address",
        "state": "State",
        "zip": "Zip code"
      },
      "sex": "Sex of the user (Stated on ID card for insurance purposes)"
    },
    "patient_id": "Patient's ID",
    "referral_info": {
      "case_qualifier": "The qualifier for case_date",
      "prior_auth_number": "The prior authorization number",
      "ref_provider_first": "The first name of the referring provider",
      "ref_provider_last": "The last name of the referring provider",
      "ref_provider_qual": "The qualifications of the referring provider"
    },
    "service_location_id": "The ID of the service location"
  }
}
```

### Result Object Field Details

You can use the result of the action's data as inputs to downstream workflow actions.

Each fetch action requires an object name, which nests the action's result data inside the downstream data context in the workflow. See [Passing Data Between Actions](https://docs.morf.health/docs/knowledge_base/passing_data_between_actions.md) for how to set it and reference the result from downstream nodes.

Here we demonstrate how to refer to this data using the prefix `$result_object_key`.

**CMS1500** `Fetch Action Response Object`

**fields**

**id** `string` *required*

CMS1500 object ID

```json CEL theme={null}
$result_object_key.id
```

```json Example theme={null}
"57211"
```

**patient\_id** `string`

`ID` Patient's ID

```json CEL theme={null}
$result_object_key.patient_id
```

```json Example theme={null}
"121250"
```

**dietician\_organization\_id** `string`

Organization ID for the User's (Patient's) registered dietitian

```json CEL theme={null}
$result_object_key.dietician_organization_id
```

```json Example theme={null}
"123450"
```

**dietitian\_organization\_id** `string`

Organization ID for the User's (Patient's) registered dietitian

```json CEL theme={null}
$result_object_key.dietitian_organization_id
```

```json Example theme={null}
"123450"
```

**dietitian\_first\_name** `string`

First name of the User's (Patient's) registered dietitian

```json CEL theme={null}
$result_object_key.dietitian_first_name
```

```json Example theme={null}
"Alexander"
```

**dietitian\_last\_name** `string`

Last name of the User's (Patient's) registered dietitian

```json CEL theme={null}
$result_object_key.dietitian_last_name
```

```json Example theme={null}
"Fleming"
```

**dietitian\_email\_address** `string`

Email address of the User's (Patient's) registered dietitian

```json CEL theme={null}
$result_object_key.dietitian_email_address
```

```json Example theme={null}
"drfleming@example.com"
```

**dietitian\_id** `string`

ID of the User's (Patient's) registered dietitian

```json CEL theme={null}
$result_object_key.dietitian_id
```

```json Example theme={null}
"100070"
```

**billing\_provider\_id** `string`

The ID of the Billing Provider

```json CEL theme={null}
$result_object_key.billing_provider_id
```

```json Example theme={null}
"PROV123"
```

**referral\_info** `object`

The referral info for the CMS1500

```json CEL theme={null}
$result_object_key.referral_info
```

```json Example theme={null}
{
"case_qualifier": "431",
"prior_auth_number": "AUTH123456",
"ref_provider_first": "John",
"ref_provider_last": "Smith",
"ref_provider_qual": "MD"
}
```

**referral\_info.ref\_provider\_qual** `string`

The qualifications of the referring provider

```json CEL theme={null}
$result_object_key.referral_info.ref_provider_qual
```

```json Example theme={null}
"MD"
```

**referral\_info.ref\_provider\_first** `string`

The first name of the referring provider

```json CEL theme={null}
$result_object_key.referral_info.ref_provider_first
```

```json Example theme={null}
"John"
```

**referral\_info.ref\_provider\_last** `string`

The last name of the referring provider

```json CEL theme={null}
$result_object_key.referral_info.ref_provider_last
```

```json Example theme={null}
"Smith"
```

**referral\_info.case\_qualifier** `string`

The qualifier for case\_date

```json CEL theme={null}
$result_object_key.referral_info.case_qualifier
```

```json Example theme={null}
"431"
```

**referral\_info.prior\_auth\_number** `string`

The prior authorization number

```json CEL theme={null}
$result_object_key.referral_info.prior_auth_number
```

```json Example theme={null}
"AUTH123456"
```

**service\_location\_id** `string`

The ID of the service location

```json CEL theme={null}
$result_object_key.service_location_id
```

```json Example theme={null}
"LOC456"
```

**organization\_info\_id** `string`

The ID of the Organization Info

```json CEL theme={null}
$result_object_key.organization_info_id
```

```json Example theme={null}
"ORG789"
```

**cms1500\_policies** `[]object` *required*

Policies in use for this claim

```json CEL theme={null}
$result_object_key.cms1500_policies
```

```json Example theme={null}
[
{
"benefits": [
{
  "coinsurance": "15",
  "copay": "50",
  "deductible_calendar_year": "2000",
  "deductible_year_to_date": "1500"
}
],
"effective_end": "2024-07-04",
"group_num": "331256",
"id": "202402",
"insurance_card_back_id": "123452",
"insurance_card_front_id": "123451",
"insurance_plan": {
"id": "611231",
"name_and_id": "Blue Cross Blue Shield - 629913",
"payer_id": "629913",
"payer_name": "Blue Cross Blue Shield"
},
"insurance_type": "Medicaid",
"notes": "Policy is active",
"num": "1912310",
"patient_id": "100121",
"priority_type": "Primary",
"updated_at": "2024-07-01T11:29:19+00:00"
}
]
```

**cms1500\_policies.map(x, x.insurance\_plan)** `[]bool` *required*

Mapped array of: Insurance plan details

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.insurance_plan)
```

```json Example theme={null}
[
{
"id": "611231",
"name_and_id": "Blue Cross Blue Shield - 629913",
"payer_id": "629913",
"payer_name": "Blue Cross Blue Shield"
}
]
```

**cms1500\_policies.map(x, x.num)** `[]string` *required*

`PII` Mapped array of: Policy number

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.num)
```

```json Example theme={null}
[
"1912310"
]
```

**cms1500\_policies.map(x, x.group\_num)** `[]string` *required*

Mapped array of: Group number

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.group_num)
```

```json Example theme={null}
[
"331256"
]
```

**cms1500\_policies.map(x, x.notes)** `[]string` *required*

Mapped array of: Notes about the policy

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.notes)
```

```json Example theme={null}
[
"Policy is active"
]
```

**cms1500\_policies.map(x, x.effective\_end)** `[]values.v1.Date` *required*

Mapped array of: Date the policy coverage expires

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.effective_end)
```

```json Example theme={null}
[
"2024-07-04"
]
```

**cms1500\_policies.map(x, x.id)** `[]string` *required*

Mapped array of: ID for the policy

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.id)
```

```json Example theme={null}
[
"202402"
]
```

**cms1500\_policies.map(x, x.patient\_id)** `[]string` *required*

`ID` `PII` Mapped array of: ID of the patient associated with the policy

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.patient_id)
```

```json Example theme={null}
[
"100121"
]
```

**cms1500\_policies.map(x, x.insurance\_card\_front\_id)** `[]string` *required*

`HI` `ID` `PII` Mapped array of: ID of the insurance card front image object

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.insurance_card_front_id)
```

```json Example theme={null}
[
"123451"
]
```

**cms1500\_policies.map(x, x.insurance\_card\_back\_id)** `[]string` *required*

`HI` `ID` `PII` Mapped array of: ID of the insurance card back image object

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.insurance_card_back_id)
```

```json Example theme={null}
[
"123452"
]
```

**cms1500\_policies.map(x, x.updated\_at)** `[]timing.v1.Timestamp` *required*

Mapped array of: Last time the Policy was updated

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.updated_at)
```

```json Example theme={null}
[
"2024-07-01T11:29:19+00:00"
]
```

**cms1500\_policies.map(x, x.insurance\_type)** `[]string` *required*

Mapped array of: The type of insurance: `type_string`

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.insurance_type)
```

```json Example theme={null}
[
"Medicaid"
]
```

**cms1500\_policies.map(x, x.priority\_type)** `[]string` *required*

Mapped array of: The priority type of insurance: `priority_type`

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.priority_type)
```

```json Example theme={null}
[
"Primary"
]
```

**cms1500\_policies.map(x, x.benefits)** `[]bool` *required*

Mapped array of: Insurance plan details

```json CEL theme={null}
$result_object_key.cms1500_policies.map(x, x.benefits)
```

```json Example theme={null}
[
[
{
"coinsurance": "15",
"copay": "50",
"deductible_calendar_year": "2000",
"deductible_year_to_date": "1500"
}
]
]
```

**client\_sig\_on\_file** `bool` *required*

True if the client's signature is on file

```json CEL theme={null}
$result_object_key.client_sig_on_file
```

```json Example theme={null}
true
```

**insured\_sig\_on\_file** `bool` *required*

True if the insured's signature is on file

```json CEL theme={null}
$result_object_key.insured_sig_on_file
```

```json Example theme={null}
true
```

**accept\_assignment** `bool` *required*

The provider agrees to accept assignment

```json CEL theme={null}
$result_object_key.accept_assignment
```

```json Example theme={null}
true
```

**icd\_codes\_cms1500s** `[]object` *required*

ICD codes in use for this claim

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s
```

```json Example theme={null}
[
{
"active": true,
"code": "F41.1",
"created_at": "2024-01-15T10:30:00Z",
"display_name": "Generalized anxiety disorder",
"end_date": "2024-12-31",
"first_symptom_date": "2024-01-10",
"id": "789012",
"updated_at": "2024-01-15T10:30:00Z"
}
]
```

**icd\_codes\_cms1500s.map(x, x.id)** `[]string` *required*

Mapped array of: The unique identifier of the CMS 1500 ICD code

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.id)
```

```json Example theme={null}
[
"789012"
]
```

**icd\_codes\_cms1500s.map(x, x.active)** `[]bool` *required*

Mapped array of: Active IcdCodesCms1500

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.active)
```

```json Example theme={null}
[
true
]
```

**icd\_codes\_cms1500s.map(x, x.display\_name)** `[]string` *required*

Mapped array of: Display name for the ICD code

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.display_name)
```

```json Example theme={null}
[
"Generalized anxiety disorder"
]
```

**icd\_codes\_cms1500s.map(x, x.created\_at)** `[]timing.v1.Timestamp` *required*

Mapped array of: Date created

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.created_at)
```

```json Example theme={null}
[
"2024-01-15T10:30:00Z"
]
```

**icd\_codes\_cms1500s.map(x, x.updated\_at)** `[]timing.v1.Timestamp` *required*

Mapped array of: Date updated

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.updated_at)
```

```json Example theme={null}
[
"2024-01-15T10:30:00Z"
]
```

**icd\_codes\_cms1500s.map(x, x.end\_date)** `[]values.v1.Date` *required*

Mapped array of: End date

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.end_date)
```

```json Example theme={null}
[
"2024-12-31"
]
```

**icd\_codes\_cms1500s.map(x, x.first\_symptom\_date)** `[]values.v1.Date` *required*

Mapped array of: ICD codes in use for this claim

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.first_symptom_date)
```

```json Example theme={null}
[
"2024-01-10"
]
```

**icd\_codes\_cms1500s.map(x, x.code)** `[]string` *required*

Mapped array of: The ICD code

```json CEL theme={null}
$result_object_key.icd_codes_cms1500s.map(x, x.code)
```

```json Example theme={null}
[
"F41.1"
]
```

**cpt\_codes\_cms1500s** `[]object` *required*

CPT codes in use for this claim

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s
```

```json Example theme={null}
[
{
"cpt_code": "99215",
"description": "New patient office visit, 45-60 minutes",
"display_name": "New patient office visit",
"mod1": "25",
"mod2": "59",
"mod3": "12",
"mod4": "34",
"pointers": "1",
"service_date": "2025-09-22",
"units": "1"
}
]
```

**cpt\_codes\_cms1500s.map(x, x.units)** `[]string` *required*

Mapped array of: Units for the CPT code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.units)
```

```json Example theme={null}
[
"1"
]
```

**cpt\_codes\_cms1500s.map(x, x.mod1)** `[]string` *required*

Mapped array of: First modification code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.mod1)
```

```json Example theme={null}
[
"25"
]
```

**cpt\_codes\_cms1500s.map(x, x.mod2)** `[]string` *required*

Mapped array of: Second modification code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.mod2)
```

```json Example theme={null}
[
"59"
]
```

**cpt\_codes\_cms1500s.map(x, x.mod3)** `[]string` *required*

Mapped array of: Third modification code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.mod3)
```

```json Example theme={null}
[
"12"
]
```

**cpt\_codes\_cms1500s.map(x, x.mod4)** `[]string` *required*

Mapped array of: Fourth modification code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.mod4)
```

```json Example theme={null}
[
"34"
]
```

**cpt\_codes\_cms1500s.map(x, x.pointers)** `[]bool` *required*

Mapped array of: Diagnostic pointers. These are used to connect Diagnosis(ICD) with appropriate Billing Item(CPT) in CMS1500 form

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.pointers)
```

```json Example theme={null}
[
"1"
]
```

**cpt\_codes\_cms1500s.map(x, x.cpt\_code)** `[]string` *required*

Mapped array of: The CPT code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.cpt_code)
```

```json Example theme={null}
[
"99215"
]
```

**cpt\_codes\_cms1500s.map(x, x.display\_name)** `[]string` *required*

Mapped array of: The CPT display name used in labels

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.display_name)
```

```json Example theme={null}
[
"New patient office visit"
]
```

**cpt\_codes\_cms1500s.map(x, x.description)** `[]string` *required*

Mapped array of: The CPT code description

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.description)
```

```json Example theme={null}
[
"New patient office visit, 45-60 minutes"
]
```

**cpt\_codes\_cms1500s.map(x, x.service\_date)** `[]values.v1.Date` *required*

Mapped array of: The service date for the specific code

```json CEL theme={null}
$result_object_key.cpt_codes_cms1500s.map(x, x.service_date)
```

```json Example theme={null}
[
"2025-09-22"
]
```

**patient** `object`

The patient for the CMS1500

```json CEL theme={null}
$result_object_key.patient
```

```json Example theme={null}
{
"date_of_birth": "1985-03-15",
"location": {
"city": "San Francisco",
"country": "USA",
"line1": "123 Main Street",
"line2": "Suite 100",
"state": "CA",
"zip": "94117"
},
"sex": "Male"
}
```

**patient.date\_of\_birth** `values.v1.Date`

Date of birth of user

```json CEL theme={null}
$result_object_key.patient.date_of_birth
```

```json Example theme={null}
"1985-03-15"
```

**patient.sex** `string`

Sex of the user (Stated on ID card for insurance purposes)

```json CEL theme={null}
$result_object_key.patient.sex
```

```json Example theme={null}
"Male"
```

**patient.location** `object`

The address of this user

```json CEL theme={null}
$result_object_key.patient.location
```

```json Example theme={null}
{
"city": "San Francisco",
"country": "USA",
"line1": "123 Main Street",
"line2": "Suite 100",
"state": "CA",
"zip": "94117"
}
```

**patient.location.line1** `string`

First line of the address

```json CEL theme={null}
$result_object_key.patient.location.line1
```

```json Example theme={null}
"123 Main Street"
```

**patient.location.line2** `string`

Second line of the address

```json CEL theme={null}
$result_object_key.patient.location.line2
```

```json Example theme={null}
"Suite 100"
```

**patient.location.city** `string`

City

```json CEL theme={null}
$result_object_key.patient.location.city
```

```json Example theme={null}
"San Francisco"
```

**patient.location.state** `string`

State

```json CEL theme={null}
$result_object_key.patient.location.state
```

```json Example theme={null}
"CA"
```

**patient.location.zip** `string`

Zip code

```json CEL theme={null}
$result_object_key.patient.location.zip
```

```json Example theme={null}
"94117"
```

**patient.location.country** `string`

Country

```json CEL theme={null}
$result_object_key.patient.location.country
```

```json Example theme={null}
"USA"
```


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