MCP server exposing 7 tools for medicare-pricing.
This URL is a JSON-RPC 2.0 endpoint over HTTP. Issue POST requests with a JSON-RPC body. Browsers and search crawlers land here on GET.
POST https://gateway.pipeworx.io/medicare-pricing/mcp
Content-Type: application/json
{"jsonrpc":"2.0","id":1,"method":"tools/list"}medicare_physician_payment — What does Medicare pay a doctor for a procedure code, in a specific place? Returns the relative value units (work, practice expense, malpractice) and the actual dollar payment for a HCPCS/CPT code, adjusted for the Medicare LOCALITY — payment varies geographically, not just by state. Answers "how much does Medicare pay for 99213", "what is code 27130 worth in Los Angeles", "reimbursement rate for an office visit in Texas", and fee-schedule or contract-rate benchmarking. Gives both the facility and non-facility amount (a procedure pays less in a hospital, because the hospital bills the overhead separately), the global period, and the status code saying whether the code is separately payable at all. States the fee-schedule YEAR and the locality it resolved to on every response, because a rate quoted for the wrong year or locality is a wrong number. Sourced from the CMS Physician Fee Schedule relative value files.medicare_lab_rate — What does Medicare pay for a laboratory test? Returns the national Clinical Laboratory Fee Schedule rate for a lab HCPCS/CPT code — lab tests are paid from their own national fee schedule rather than the physician schedule, so there is one rate and no locality adjustment. Answers "how much does Medicare pay for a comprehensive metabolic panel", "CLFS rate for 80053", "what does a lipid panel reimburse". States the year and quarter of the schedule used, since lab rates are republished quarterly. Sourced from the CMS Clinical Laboratory Fee Schedule.medicare_dmepos_rate — What does Medicare pay for a piece of durable medical equipment, prosthetic, orthotic, or medical supply (DMEPOS)? Returns the fee-schedule amount for a HCPCS Level II code (E/K/L/A-codes — CPAP machines, wheelchairs, ostomy supplies, braces, oxygen equipment...) in a given US state, with SEPARATE rural and non-rural amounts, since Medicare pays DMEPOS by state rather than by the physician-fee-schedule locality. Answers "how much does Medicare pay for a CPAP machine (E0601)", "DMEPOS rate for a wheelchair in Texas", "what is the rural rate for this HCPCS code in Montana". Unlike medicare_physician_payment, this DOES include the HCPCS code description — DMEPOS uses HCPCS Level II, which CMS itself maintains and is not AMA copyright (CPT/HCPCS Level I is). States the fee-schedule YEAR and RELEASE (quarterly-ish: A=January, B=April, C=July, D=October) used on every response, and the modifier resolved (many DMEPOS codes price differently for rental "RR" vs. new purchase "NU" vs. used "UE" — pass one if you know it, otherwise the first modifier on file for the code is used and stated).medicare_code_units_limit — How many units of a procedure code will Medicare pay for one patient in one day? Returns the NCCI Medically Unlikely Edit (MUE) — the maximum units allowed — with the adjudication indicator saying whether the limit is absolute or can be overridden with documentation, and the rationale for it. Answers "what is the MUE for 99213", "how many units of this code can I bill", "why was my claim denied for units". Available for practitioner, outpatient hospital and DME settings, which have different limits for the same code. States the quarterly edit vintage in force. Sourced from the CMS National Correct Coding Initiative.check_code_pair — Can two procedure codes be billed together on the same day? Checks the CMS National Correct Coding Initiative procedure-to-procedure (PTP) edit for a pair of HCPCS/CPT codes and returns the modifier indicator saying whether the pair can never be unbundled, can be unbundled with an appropriate modifier and documentation, or carries no edit in the loaded data. Answers "can I bill 99214 and 93000 together", "is there an NCCI edit between these two codes", "do I need a modifier for this code combination". Built from CMS's FULL NCCI PTP edit baseline (2026q3, v322r0), not just a rolling change window — a pair not found here has never had a CMS-recorded PTP edit as of the loaded vintage. The response always states the loaded vintage and setting resolved.explain_ncci_edit — What NCCI procedure-to-procedure edits exist for a single code? Lists the other codes this HCPCS/CPT code has a recorded PTP edit with — whether it is the code you bill (Column 1) or the one bundled into another (Column 2) — with each pair's modifier indicator. Answers "what codes conflict with 99214", "what is bundled into this procedure", "why would this code be denied when billed with something else". Same full-baseline coverage as check_code_pair (CMS's FULL NCCI PTP edit baseline, 2026q3 v322r0, not just a rolling change window) — an empty result means no PTP edit has ever been recorded for this code, not merely "no recent change".medicare_pricing_coverage — What Medicare pricing data is loaded and how current it is: the fee-schedule years and quarters held, how many codes are in each dataset, how many localities, and the PTP pair-edit change window. Use to check a vintage is current enough to quote before relying on a rate, and to see the scope limit on check_code_pair / explain_ncci_edit — they see only pairs that changed within the loaded quarterly window, not the full AMA-licence-gated PTP baseline.Code samples (curl / TypeScript / one-click client install), schemas, and the live playground are on the pack page:
https://pipeworx.io/packs/medicare-pricing/
Pipeworx is an open MCP gateway connecting AI agents to live data. pipeworx.io