Medicare Pricing MCP server

medicare-pricing

What Medicare pays — physician fee schedule, lab rates, and per-day unit limits. The companion to medicare-coverage, which answers whether something is covered but not what it is worth.

Part of Pipeworx — an MCP gateway connecting AI agents to 1576+ live data sources.

Tools

Auth

None. No key, no account.

Data sources

All from CMS, all downloadable files with no API:

• Physician Fee Schedule relative value files (RVUs + GPCIs) — annual
• Clinical Laboratory Fee Schedule — quarterly
• DMEPOS fee schedule (durable medical equipment, prosthetics, orthotics, supplies) — quarterly (as necessary): A=Jan, B=Apr, C=Jul, D=Oct
• NCCI Medically Unlikely Edits — quarterly
• NCCI PTP quarterly additions/deletions/revisions files — quarterly (see below — a narrower source than the other three)

Vintage is not a detail

Fee schedules change annually and NCCI/CLFS quarterly. Quoting a 2026 procedure at 2024 rates is a wrong number with billing consequences, so every response states the year (and quarter where quarterly) it used, and sets yearwasdefaulted when the caller did not name one. Asking for a year that is not loaded returns yearnotloaded rather than silently answering with a different year's rates.

Locality is not state

Medicare pays by geographic locality. California alone has nine. The same office visit (99213, 2026) pays:

A 13% swing a state-shaped answer would hide. medicarephysicianpayment resolves the locality explicitly, states what it resolved to, and lists other localities that matched so a caller can pick a different one.

Payment is computed with the real formula and the arithmetic is returned so it can be audited:

((work RVU × PW GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)) × conversion factor

Facility and non-facility are both given — a procedure pays less in a hospital because the facility bills its own fee separately.

Whether two codes can be billed together — the full PTP baseline

checkcodepair and explainncciedit now cover the FULL NCCI procedure-to-procedure (PTP) edit baseline, not a rolling change window (fleet #1293, 2026-09-07). CMS distributes the complete PTP edit table behind an AMA CPT licence click-through (/license/ama?file=... on cms.gov). Bruce authorized accepting that licence on the company's behalf via the Needs Bruce dashboard (2026-09-07); the licence text was read in full before any data shipped — see "NCCI PTP licence" below for the quoted terms and the reasoning for why this pack's serving shape stays inside them.

Shortened. The full README is on GitHub.