sqllocks-shape-healthcare-codes

Shape plugin: healthcare reference code sets, validators and detectors. It is the code layer under a domain pack: the domain asks it for codes that are real, valid on the date of service, and licensed for the way they are used.

• Code sets: ICD-10-CM, ICD-10-PCS, HCPCS Level II, FDA NDC, RxNorm (prescribable), CMS place of service, CMS-HCC mappings, AHRQ CCSR, and the international ICD-10 family, all behind one code model (CodeSet). Free sets are built from the official source at a pinned release with shape healthcare-codes fetch; licensed sets (CPT, SNOMED CT, UB-04 revenue codes and type of bill, NUCC taxonomy, CARC/RARC, WHO ICD-10, ICD-10-GM, ICD-10-AM) are bring-your-own: you supply the file, a loader reads it, and nothing licensed is shipped.
• Risk adjustment: the hierarchies and coefficients of the CMS-HCC, ESRD and RxHCC models (hcc_hierarchy, hcc_coefficients, built from the CMS model software), and a reference scoring function (risk_score) for testing generated data; not a certified implementation.
• Validators: ICD-10-CM valid and billable on a date of service, NDC valid and marketed on a fill date, NPI check digit with a synthetic never-assigned range, age and sex edits.
• Detectors (shape.detectors): ICD-10, NDC, NPI, HCPCS, CPT, Medicare MBI and member-id columns.
• Wheel size: the wheel is about 0.7 MB (a 0.6 MB starter subset of ICD-10-CM and the code). The full sets are built on your machine with shape healthcare-codes fetch.

THIRD_PARTY_NOTICES.md records, for every asset, the source URL, release, licence (quoted from the source's own page, with the date it was read), and whether it is shipped, fetched or bring-your-own. the implementation tests records the checks.

import datetime as dt
from shape_healthcare_codes import load, icd10cm_valid_billable

icd = load("icd10cm")  # after `shape healthcare-codes fetch icd10cm`
icd10cm_valid_billable(icd, "E11.9", dt.date(2026, 10, 2))  # True
icd10cm_valid_billable(icd, "E11", dt.date(2026, 10, 2))  # False: a header, not billable

The domain-facing API is documented in docs/plugins/healthcare-codes.md.