# 2023 emergency MDM (ACEP) 2023 emergency MDM (ACEP) Status: LIVE Price: $0.005 USDC `GET /api/calc/em_mdm` HTML: https://magentlab.com/docs/em-mdm Markdown: https://magentlab.com/docs/em-mdm.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Return the 2023 overall medical decision making level from caller-assigned problems, data, and risk using AMA CPT Table 1 as reprinted by ACEP (highest level at which at least 2 of 3 elements are met or exceeded). ## When to use When an agent already has the three 2023 MDM element levels (straightforward, low, moderate, or high) and needs the overall MDM the table prints. magent does not examine the patient, count tests, or assign a CPT code. ## When not to use - Not a medical device. - Not a bill or CPT assignment. magent does not code the chart. - The caller assigns number and complexity of problems addressed, amount and/or complexity of data, and risk of complications and/or morbidity of management. magent does not count tests, review notes, or determine risk from the record. - Not a diagnosis. ## Formula ``` Caller-assigned number and complexity of problems addressed, amount and/or complexity of data, and risk of complications and/or morbidity of management using the printed 2023 MDM column labels straightforward, low, moderate, and high; overall MDM is the highest level at which at least 2 of 3 elements are met or exceeded (AMA CPT 2023 Table 1 as reprinted by ACEP) ``` ## Citation [CPT Evaluation and Management (E/M) Code and Guideline Changes](https://www.acep.org/siteassets/sites/acep/media/reimbursement/2023-e-m-descriptors-guidelines.pdf) American Medical Association; American College of Emergency Physicians AMA CPT 2023 Table 1, Levels of Medical Decision Making, effective January 1, 2023. ACEP reprint. DOI: none ## Worked example ### Low MDM (1 stable chronic illness, limited data, low risk) Given: `data=low, problems=low, risk=low` 1. problems low (table: 1 stable chronic illness), data low (table: limited), risk low 2. 2 of 3 elements meet or exceed low → overall MDM low ### High MDM by 2 of 3 elements Given: `data=low, problems=high, risk=high` 1. problems high, data low, risk high 2. 2 of 3 elements meet or exceed high → overall MDM high ## Also searched as - emergency MDM - medical decision making - ACEP 2023 MDM - E/M MDM - 2023 ED MDM - problems data risk MDM ## Parameters - `problems` (string, required): Caller-assigned number and complexity of problems addressed using the printed 2023 MDM column labels straightforward, low, moderate, or high (AMA CPT 2023 Table 1 as reprinted by ACEP). straightforward is the table's minimal column (1 self-limited or minor problem). low includes 1 stable chronic illness, 2 or more self-limited or minor problems, or 1 acute uncomplicated illness or injury. magent does not code the chart. - `data` (string, required): Caller-assigned amount and/or complexity of data to be reviewed and analyzed using the printed 2023 MDM column labels straightforward, low, moderate, or high. straightforward is the table's minimal or none column; low is limited; moderate is moderate; high is extensive. magent does not count tests, notes, or independent historians. - `risk` (string, required): Caller-assigned risk of complications and/or morbidity of management using the printed 2023 MDM column labels straightforward, low, moderate, or high (straightforward is the table's minimal risk column). magent does not determine risk from the record. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/em_mdm` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "data": "low", "problems": "low", "risk": "low" }, { "data": "low", "problems": "low", "risk": "low" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/em-mdm Example 200: ```json { "count": 2, "path": "/api/calc/em_mdm", "items": [ { "data": "low", "description": "Low medical decision making", "components": [ { "value": "low", "factor": "problems", "met": true }, { "value": "low", "factor": "data", "met": true }, { "value": "low", "factor": "risk", "met": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "American Medical Association; American College of Emergency Physicians", "id": "acep-2023-em-mdm", "source": "AMA CPT 2023 Table 1, Levels of Medical Decision Making, effective January 1, 2023. ACEP reprint.", "title": "CPT Evaluation and Management (E/M) Code and Guideline Changes" }, "formula": "em_mdm", "formula_expression": "Caller-assigned number and complexity of problems addressed, amount and/or complexity of data, and risk of complications and/or morbidity of management using the printed 2023 MDM column labels straightforward, low, moderate, and high; overall MDM is the highest level at which at least 2 of 3 elements are met or exceeded (AMA CPT 2023 Table 1 as reprinted by ACEP)", "risk": "low", "mdm": "low", "problems": "low" }, { "data": "low", "description": "Low medical decision making", "components": [ { "value": "low", "factor": "problems", "met": true }, { "value": "low", "factor": "data", "met": true }, { "value": "low", "factor": "risk", "met": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "American Medical Association; American College of Emergency Physicians", "id": "acep-2023-em-mdm", "source": "AMA CPT 2023 Table 1, Levels of Medical Decision Making, effective January 1, 2023. ACEP reprint.", "title": "CPT Evaluation and Management (E/M) Code and Guideline Changes" }, "formula": "em_mdm", "formula_expression": "Caller-assigned number and complexity of problems addressed, amount and/or complexity of data, and risk of complications and/or morbidity of management using the printed 2023 MDM column labels straightforward, low, moderate, and high; overall MDM is the highest level at which at least 2 of 3 elements are met or exceeded (AMA CPT 2023 Table 1 as reprinted by ACEP)", "risk": "low", "mdm": "low", "problems": "low" } ] } ``` ## Response fields - `formula` (string): em_mdm - `formula_expression` (string): Published 2023 MDM 2-of-3 met-or-exceeded rule - `problems` (string): Caller-assigned problems-addressed column: straightforward, low, moderate, or high - `data` (string): Caller-assigned data column: straightforward, low, moderate, or high - `risk` (string): Caller-assigned risk column: straightforward, low, moderate, or high - `mdm` (string): Overall MDM: highest of straightforward, low, moderate, or high at which at least 2 of 3 elements are met or exceeded - `description` (string): Published 2023 wording for that overall MDM type - `components` (array): problems, data, and risk criterion rows; met is true when that element meets or exceeds overall MDM - `citation` (object): ACEP reprint of AMA CPT 2023 Table 1 - `disclaimer` (string): Not a medical device ## Example JSON Frozen fixture. Not a live lookup. ```json { "data": "low", "description": "Low medical decision making", "components": [ { "value": "low", "factor": "problems", "met": true }, { "value": "low", "factor": "data", "met": true }, { "value": "low", "factor": "risk", "met": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "American Medical Association; American College of Emergency Physicians", "id": "acep-2023-em-mdm", "source": "AMA CPT 2023 Table 1, Levels of Medical Decision Making, effective January 1, 2023. ACEP reprint.", "title": "CPT Evaluation and Management (E/M) Code and Guideline Changes" }, "formula": "em_mdm", "formula_expression": "Caller-assigned number and complexity of problems addressed, amount and/or complexity of data, and risk of complications and/or morbidity of management using the printed 2023 MDM column labels straightforward, low, moderate, and high; overall MDM is the highest level at which at least 2 of 3 elements are met or exceeded (AMA CPT 2023 Table 1 as reprinted by ACEP)", "risk": "low", "mdm": "low", "problems": "low" } ``` ## Errors - HTTP 400 `invalid_em_mdm`: 2023 emergency MDM inputs must match the printed problems, data, and risk columns. Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [ASA-PS](https://magentlab.com/docs/asa-physical-status) — Return the caller-assigned ASA Physical Status class 1-6 with optional emergency suffix E and the published class definition (ASA 2014, last amended 2020). ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.