# Medicare Coverage [Health: Active]

**Category:** 🧬 Biology & Bioinformatics  
**Repository:** https://github.com/pipeworx-io/mcp-medicare-coverage  
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**Directory Page:** https://allmcps.com/mcp/medicare-coverage

## Description
Medicare coverage policy from CMS: national and local coverage determinations, plus open analyses

## Tools
Capabilities this server exposes over MCP:

- **medicare_ncd_search** — ANSWERS "does Medicare cover X" / "is X covered by Medicare" / "what is Medicare's coverage policy for X" — searches current Medicare National Coverage Determinations (NCDs), the national policy documents that say whether Medicare covers a drug, device, procedure or therapy. Search by everyday prod…
- **medicare_ncd_detail** — Retrieve one official Medicare National Coverage Determination by CMS document ID and optional version, including covered indications, limitations, effective dates, benefit category, and revision text.
- **medicare_lcd_search** — Search current final Medicare Local Coverage Determinations (LCDs), optionally restricted to a state. LCDs are contractor- and jurisdiction-specific and can differ across locations.
- **medicare_lcd_detail** — Retrieve one Medicare LCD by document ID and version. Detailed LCD text requires a CMS license-agreement bearer token because documents may contain licensed AMA/ADA/AHA material; pass _licenseToken obtained directly from CMS after accepting those terms.
- **medicare_nca_search** — Search National Coverage Analyses (NCAs) and Coverage Analyses for Labs (CALs), including open and completed CMS evidence reviews. An open analysis is a policy process, not a coverage decision.
- **medicare_nca_detail** — Retrieve one CMS National Coverage Analysis by document ID, including request, issue, benefit category, dates, decision memo, and public-comment status when supplied by CMS.
- **medicare_recent_coverage_changes** — Recently published or updated national Medicare coverage documents from CMS, including NCDs, NCAs, CALs, MEDCAC meetings, and technology assessments.
- **medicare_coverage_states** — List CMS Coverage API state identifiers used to scope local Medicare coverage searches.
- **medicare_article_code_profile** — Retrieve one CMS Medicare Coverage Article with its CPT/HCPCS codes and contractor records. Licensed AMA/ADA/AHA content requires a caller-provided CMS license token. Code inclusion describes billing guidance, not guaranteed coverage or payment.
- **medicare_local_coverage_variation** — Compare final LCD search matches across 1–15 states and Medicare Administrative Contractors. Different matching document counts or titles are policy signals, not proof of unequal beneficiary access or payment.
- **medicare_coverage_timeline** — Retrieve official CMS version or revision history for a Medicare NCD, NCA, CAL, or LCD. Accepts either identifier CMS publishes for a coverage document: the public one that appears in the policy text and in every citation of it — an NCD section number such as 310.1 or 90.2, an NCA/CAL tracking numb…
- **medicare_hcpcs_utilization_trend** — Show annual Medicare Physician & Other Practitioners national utilization and payment metrics for one HCPCS code. Claims are fee-for-service aggregates with suppression and methodology limits; they do not measure total US use, coverage, demand, or company revenue.
- **medicare_hcpcs_geography** — Compare state-level Medicare fee-for-service provider, beneficiary, service, and average-payment metrics for one HCPCS code and program year. State beneficiary counts across places of service must not be summed as unique people.
- **medicare_provider_exposure** — Return a bounded sample of provider-level Medicare fee-for-service rows for one HCPCS code, optionally filtered by state, with the authoritative matching-row count. This is not a provider ranking and excludes suppressed/non-FFS activity.
- **medicare_product_market_profile** — UTILIZATION ANALYTICS for a product whose HCPCS billing codes you ALREADY KNOW: requires 1-5 caller-supplied HCPCS codes and combines their annual Medicare fee-for-service claim volumes and payments with matching coverage-policy documents. Use when you have the codes and want spend, volume and tren…
- **medicare_part_d_top_drugs** — Rank Medicare Part D drugs by total gross spending for a year — the biggest drugs in the Part D program, highest first. Answers "which drugs have the highest Medicare Part D spending", "top Part D drugs by cost", "what does Medicare spend the most on". Returns brand name, generic name and total spe…
- **medicare_part_d_drug_spending** — Search CMS Medicare Part D spending by brand or generic name and return 2020–2024 spending, claims, beneficiaries, dosage units, and unit-cost trends. Gross Part D spending is not manufacturer revenue, net price, profit, prescriptions, or total US sales.
- **medicare_part_d_prescriber_exposure** — Return a bounded sample of Medicare Part D prescriber-by-drug rows for an exact brand name in one year, optionally filtered by state, with the authoritative matching-row count. This is not a prescriber ranking and suppressed/non-Part-D activity is absent.
- **medicare_part_d_generic_competition** — Profile Medicare Part D brand rows sharing an exact generic name, including CMS’s reported manufacturer count and 2020–2024 spending/use trends. Manufacturer count is a CMS aggregate, not a list of companies, products on market, or market share.
- **medicare_inpatient_drg_market** — Return a bounded sample of hospital-level Medicare fee-for-service inpatient rows for an exact MS-DRG and year, optionally filtered by state, with the authoritative matching-row count. Average payments are not hospital revenue or margin.
- **medicare_outpatient_apc_market** — Return a bounded sample of hospital-level Medicare fee-for-service outpatient rows for an exact APC and year, optionally filtered by state, with the authoritative matching-row count. APC payments are claims aggregates, not hospital revenue or margin.
- **medicare_hospital_service_trend** — Show annual national Medicare fee-for-service utilization and average-payment trends for one inpatient MS-DRG or outpatient APC using CMS geography/service aggregates. Trends exclude Medicare Advantage and do not measure total market demand, revenue, or profitability.
- **medicare_dme_supplier_market** — Return a bounded API-order sample of Medicare fee-for-service DME supplier rows for an exact HCPCS code and year, optionally filtered by state, with the authoritative matching-row count. This is not a supplier ranking or total market size.
- **medicare_dme_service_trend** — Show annual national Medicare fee-for-service DME supplier, beneficiary, claim, service, and average-payment metrics for one HCPCS code. It excludes Medicare Advantage and is not total market demand or company revenue.
- **medicare_post_acute_provider_market** — Return a bounded API-order sample of Medicare post-acute provider rows for home health, hospice, or skilled nursing in one year and optional state, with the authoritative matching-row count. Payments are not provider revenue or margin.
- **medicare_post_acute_trend** — Show annual national Medicare fee-for-service beneficiaries, stays, service days, and payments for home health, hospice, or skilled nursing. Program definitions and year basis differ by service and the figures are not provider revenue.
- **medicare_enrollment_trend** — Show annual Medicare enrollment and Medicare Advantage/other, Original Medicare, Part D PDP, Part D MA-PD, and dual-eligible counts nationally or for one state. Enrollment counts are program participation, not utilization or revenue.

## Claude Desktop Quick Installation
Install path detected from listing signals. Uses `npx` (confidence: high):

```json
"mcpServers": {
  "medicare-coverage": {
    "command": "npx",
    "args": ["-y","@pipeworx/mcp-medicare-coverage"]
  }
}
```

## Documentation

## What Medicare Coverage does

The Medicare Coverage MCP server connects an MCP client to CMS Medicare coverage policy and public program data. It supports searches and document retrieval for National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), National Coverage Analyses (NCAs), Coverage Analyses for Labs (CALs), coverage articles, and recent policy changes.

The server also exposes analytics for CMS claims and enrollment datasets. These include HCPCS utilization, state geography, provider exposure, hospital inpatient and outpatient markets, durable medical equipment suppliers, post-acute providers, Part D drug spending, generic competition, and national or state Medicare enrollment.

## How it works

An MCP client sends tool calls to the remote endpoint. Search tools accept policy or product-related terms and can scope local coverage searches by state. Detail tools retrieve a CMS document using its identifier and, where supported, a version. The timeline tool accepts public identifiers such as an NCD section number, an NCA or CAL tracking number, an LCD number, or a CMS internal document ID, then reports the resolved identifiers.

The Medicare Coverage MCP server separates policy evidence from utilization analysis. For example, an NCD describes national policy, while HCPCS and hospital tools report fee-for-service aggregates. Product market profiling requires the caller to supply one to five HCPCS codes; CMS does not validate that a product-to-code mapping is correct.

## Setup and configuration

Configure an MCP client with the streamable HTTP endpoint:

```json
{
  "mcpServers": {
    "medicare-coverage": {
      "url": "https://gateway.pipeworx.io/medicare-coverage/mcp"
    }
  }
}
```

The README identifies Claude Desktop, Cursor, and Windsurf as example clients. No environment variables are specified for this remote configuration.

Some tools accept a caller-provided `_licenseToken`. CMS requires a license-agreement bearer token for detailed LCD text, certain coverage article content, and LCD revision history when the material includes licensed AMA, ADA, or AHA content. The token must be obtained directly from CMS after accepting its terms.

## Tools and capabilities

- Search and retrieve national and local coverage documents.
- Search open or completed CMS evidence analyses and inspect decision details.
- Compare LCD matches across one to fifteen states or Medicare Administrative Contractors.
- Review policy publication and revision histories.
- Inspect CPT or HCPCS codes associated with coverage articles.
- Analyze Part D spending, claims, beneficiaries, dosage units, and unit-cost trends.
- Compare national or state utilization, payments, providers, suppliers, hospitals, and enrollment.

## Limitations and notes

Coverage documents are policy sources, not individualized coverage guarantees or medical advice. An open NCA is an ongoing policy process, not a coverage decision. LCD differences indicate policy variation signals, not proof of unequal access or payment.

Claims and enrollment outputs have defined scope and methodological limits. Many analytics exclude Medicare Advantage, use fee-for-service aggregates, suppress some records, or return bounded samples. Payment figures are not necessarily revenue, margin, manufacturer revenue, total market demand, or total United States use. Part D spending is gross spending before confidential rebates, and state beneficiary counts across places of service must not be added as unique people.

_Full upstream README: https://allmcps.com/mcp/medicare-coverage/readme_