# AutomatedRCM Prior Authorization Check (PAT)

> AutomatedRCM Prior Authorization Check (PAT) is a paid API for AI agents from x402.getautomatedrcm.com, paid per call via x402, $0.05/call, status unknown (last checked 2026-09-13).

Determines whether a CPT/HCPCS procedure code requires prior authorization from a specific US payer, returning requirements, clinical criteria, documentation checklist, payer portal link, and turnaround time.

## Facts

- Endpoint: POST https://x402.getautomatedrcm.com/pa-check
- Price: $0.05/call
- Payment: x402
- Status: unknown
- Last checked: 2026-09-13
- Activations on Zero: 0
- Tags: x402
- Canonical page: https://www.zero.xyz/c/automatedrcm-prior-authorization-check-pat-9aecae8f
- Structured record (JSON): https://api.zero.xyz/v1/capabilities/cap_Ah1PNc3leMPR1MgaaeKGU

Status and success rate cover calls made through Zero and Zero's own probes. Third-party monitors may report differently.

## How to call it through Zero

Zero handles the 402 payment challenge and records the run. With the Zero CLI installed (`npm i -g @zeroxyz/cli`):

```sh
zero fetch --capability automatedrcm-prior-authorization-check-pat-9aecae8f -d '<json body>'
```

Example prompt: Does CPT code 27447 (total knee replacement) require prior authorization with UHC, and if so, what documentation and clinical criteria do I need to submit?

## When to prefer this

Use this endpoint when you need a fast, rule-based prior authorization determination for a specific CPT or HCPCS code against one of the seven major US payers (UHC, Aetna, Cigna, Florida Blue, Humana, Medicare, Medicare Advantage). It is purpose-built for the 13 highest-volume clinical categories (imaging, surgery, sleep, cardiology, pain management, wound care, specialty drugs) and returns actionable output including documentation checklists and portal links. Prefer this over general payer portal lookups when you need structured, machine-readable PA requirements that can be fed directly into an RCM workflow.

## Known failure modes

- CPT/HCPCS code outside the 13-code ruleset — returns coverage:false with guidance but no PA details
- Unsupported payer name — request may fail or return no match
- Malformed CPT code string — validation error
- ICD-10 code mismatch may affect criteria precision if provided incorrectly
- Network or payment failure if x402 micropayment not processed

## How this service works

Prior-authorization determination for a CPT/HCPCS code + US payer. Rules engine covering UHC, Aetna, Cigna, Florida Blue, Humana, Medicare, Medicare Advantage across 13 high-volume codes (imaging, surgery, sleep, cardiology, pain mgmt, wound care, specialty drugs). Returns requirement, criteria, documentation checklist, payer portal + turnaround. Codes outside the ruleset return coverage:false with guidance (no charge avoidance — check GET / for the covered list first). (AutomatedRCM agent: PAT)

## Output

Returns a structured response indicating whether prior authorization is required (coverage flag), the specific clinical criteria the payer applies, a checklist of required documentation, the payer's submission portal URL, and expected turnaround time. For CPT/HCPCS codes outside the supported ruleset, returns coverage:false with guidance to check the covered code list.

## Request schema (JSON Schema)

```json
{
 "type": "object",
 "properties": {
  "cpt": {
   "type": "string",
   "description": "CPT/HCPCS procedure code, e.g. 29881"
  },
  "icd10": {
   "type": "string",
   "description": "Optional ICD-10 diagnosis code"
  },
  "payer": {
   "type": "string",
   "description": "US payer: UHC, AETNA, CIGNA, FLBLUE, HUMANA, MEDICARE, MEDICARE_ADV"
  }
 }
}
```

## More

- Live health (JSON, refreshed every minute): https://www.zero.xyz/c/automatedrcm-prior-authorization-check-pat-9aecae8f/health.json
- [Zero catalog index](https://www.zero.xyz/llms.txt)
- [Other services from x402.getautomatedrcm.com](https://www.zero.xyz/host/x402.getautomatedrcm.com/llms.txt)