# MyMedi-AI/mymedi-ai-mcp-server [Health: Active]

**Category:** 🧬 Biology & Bioinformatics  
**Repository:** https://github.com/MyMedi-AI/mymedi-ai-mcp-server  
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**Directory Page:** https://allmcps.com/mcp/mymedi-ai-mymedi-ai-mcp-server

## Description
Healthcare billing AI for agents: ICD-10/CPT/HCPCS code lookup (81,769 codes with RVU + OPPS pricing), prior auth prediction, medical NER, claims validation, denial-risk scoring, HIPAA compliance auditing, and NPI/drug enrichment. 20 tools, 10 free credits then pay-per-call via credits or anonymous USDC (x402). npx @mymedi-ai/mcp-server

## Tools
Capabilities this server exposes over MCP:

- **pa_required_check** — Check whether a HCPCS code is on the CMS Required Prior Authorization List (42 CFR 414.234). Returns paRequired flag, category, nationwide-since date, and list version. Original Medicare FFS scope. Free, no API key required.
- **denial_code_info** — Explain a DME claim denial code (CARC). Returns title, meaning, common DME causes, fixes, appealability, and related codes. Free, no API key required.
- **code_lookup_basic** — Look up basic metadata for a medical code: code, codeType, description, category, isActive. Basic metadata only — the paid code_lookup adds full metadata. Free, no API key required.
- **reimbursement_basic** — Look up Medicare payment for a code. Returns the national PFS facility and non-facility payment (CMS RVU × conversion factor) for professional services, plus DMEPOS fee-schedule ranges (rental/purchase, min–max across state fees) for DME items like E/K/L codes. Free, no API key required.
- **order_readiness_checklist** — Blank pre-delivery checklist for a HCPCS DMEPOS code: the universal standard written order (SWO) elements (42 CFR 410.38(d)), whether the code requires a face-to-face encounter and written order prior to delivery (F2F/WOPD), and whether it is on the Medicare Required Prior Authorization List. Requirement definitions only — PHI-free, never send patient data. Free, no API key required.
- **modifier_advisor** — Editorial guidance on DMEPOS billing modifiers: the KX/GA/GY/GZ medical-necessity and liability family, RR/NU/UE rental-vs-purchase, capped-rental month markers (KH/KI/KJ), and RT/LT laterality. Pass a HCPCS code to scope guidance to that item's DMEPOS category, or a category directly; add a scenario phrase (e.g., "ABN on file", "bilateral") to surface the relevant modifiers. Original editorial content, not payer policy. PHI-free. Free, no API key required.
- **code_lookup** — Look up a medical code (ICD-10, CPT, HCPCS). Returns description, category, active status, and related codes. For DMEPOS (HCPCS) codes it also returns a labeled fee schedule: per-modifier (RR/NU/UE) national min–max ranges, or — when a state is given — that state's exact non-rural and rural rates. Source: CMS DMEPOS Fee Schedule (DME26-B).
- **code_lookup_batch** — Look up a list of medical codes (ICD-10, CPT, HCPCS) in one call. Per-item results mirror code_lookup (description, category, active status, related codes, DMEPOS fee schedule with optional state filter). Priced per code — $0.001 × number of codes, max 25 per call; the full charge is refunded automatically when every code misses.
- **code_suggest** — Suggest ICD-10/CPT/HCPCS codes from a clinical description. Term-based search over the 90K-code CMS database, ranked by matched-term coverage and relevance. Works with natural sentences ("patient with obstructive sleep apnea prescribed CPAP"). Automatically refunds the call when nothing matches.
- **code_validate** — Validate a medical code for correctness, active status, and context. Returns warnings and errors.
- **code_validate_batch** — Validate a list of medical codes for correctness, active status, and optional date-of-service context in one call. Per-item results mirror code_validate (valid, active, warnings, errors, codeDetails). Priced per code — $0.005 × number of codes, max 25 per call. An invalid code is a billable answer (valid:false), same as the single validate.
- **pa_predict** — Prior-authorization outlook for a procedure code. When a historical cohort of decided PAs exists (≥10), returns a data-driven approval rate with cohort size and confidence. When no cohort exists, returns the verifiable facts instead — CMS Required Prior Authorization List status, category, and published review timeframes — and explicitly reports that no probability was computed (the call is refunded on this path). Never fabricates a probability. Original Medicare FFS scope.
- **pa_status** — Check the status of a prior authorization request tracked in your MyMedi-AI web workspace (by its MyMedi-AI PA id). Returns current status, dates, and expiration info. It does not query payers, and returns not-found (refunded) if the PA was never entered in the web app — for a code's PA requirement use the free pa_required_check.
- **pa_exposure_report** — Map a supplier HCPCS catalog against the CMS Required Prior Authorization List (74 items) and the Required Face-to-Face Encounter & Written Order Prior to Delivery List (83 items, effective 2026-04-13). Per code: PA requirement with nationwide-since date, F2F/WOPD requirement, documentation gates (SWO, UTN-before-claim, F2F/WOPD sequencing), and deterministic denial-risk flags — plus a catalog-level exposure summary. Unknown or non-HCPCS codes are flagged and count as billable answers. Priced per code — $0.01 × number of codes, max 100 per call. Returns JSON here; the REST endpoint also renders a branded PDF with {"format":"pdf"}. Original Medicare FFS scope. PHI-free: codes in, rules out.
- **ner_extract** — Extract medical codes and clinical terms already present in free text: ICD-10, CPT and HCPCS codes, dates, and medication names, each with a span and a pattern-based confidence. Deterministic pattern extraction — it does not infer or suggest codes (use code_suggest for that). PHI-free: send de-identified text only.
- **claims_validate** — Pre-submission claims validation. Checks for errors, missing fields, code mismatches, and provides fix suggestions before you submit to the payer.
- **compliance_audit** — PHI exposure scan for a text payload before it leaves your system: pattern checks for SSN, MRN and date-of-birth formats, with findings by severity, a 0-100 score and remediation notes. Pattern-based, not a full HIPAA audit. Costs 250 credits — run it on a sample, not on every record.
- **drug_lookup** — Look up drug information including label data, adverse events, and related diagnosis codes. Source: OpenFDA (public domain).
- **drug_interactions** — Check drug-drug interaction signals from FDA adverse event co-reports. Returns co-reported reactions and signal strength. Source: OpenFDA FAERS (public domain).
- **code_reimbursement** — Look up Medicare reimbursement rates for a medical code. Returns RVU values and estimated payment amounts using CMS PFS conversion factor. Source: CMS PFS RVU 2026 (public domain).
- **fee_schedule_lookup** — Look up the CMS DMEPOS fee schedule for a DME/orthotic/prosthetic HCPCS code: rental (RR) vs purchase (NU new / UE used), non-rural vs rural, per state. Give a state for exact rates, or omit for national min–max ranges; filter by modifier to narrow to rental or purchase. Source: CMS DMEPOS Fee Schedule DME26-B (Apr 2026). For professional-service (CPT) payment use code_reimbursement instead.
- **trials_search** — Search active clinical trials by condition, ICD-10 code, or intervention. Returns trial details including NCT ID, phase, enrollment, and eligibility. Source: ClinicalTrials.gov (public domain).
- **code_crossref** — Cross-reference a medical code across ICD-10, CPT, and HCPCS systems. Returns related codes grouped by system. Source: CodeReference DB (ICD-10/HCPCS: public domain).
- **drug_rxnorm** — Look up a drug in NIH RxNorm for normalized terminology (RxCUI) and optionally check clinical drug-drug interactions with severity ratings. Source: NIH RxNorm (public domain).
- **provider_payments** — Look up pharmaceutical and device company payments to a physician (Sunshine Act data). Returns total payments, breakdown by type, and top paying companies. Source: CMS Open Payments (public domain).
- **disease_surveillance** — Look up disease surveillance data including case counts and trends by condition and geography. Source: CDC National Notifiable Diseases Surveillance System (public domain).
- **provider_search** — Search the NPI provider directory. Find healthcare providers by name, specialty, or location.
- **provider_enrich** — AI-enriched provider intelligence from NPI number. Returns practice details, specialties, affiliations, and market context.
- **drug_enrich** — Drug information enrichment via OpenFDA. Returns drug details, indications, interactions, and AI analysis.
- **market_analysis** — Healthcare specialty market analysis for a specific state. Returns provider density, competition metrics, and market opportunity data.
- **account_status** — Check your MyMedi-AI account: current credit balance, USD equivalent, transaction count, recent transactions, and last activity. Free — never bills credits. Uses your connector sign-in (or X-API-Key when self-hosted).
- **buy_credits** — Top up your MyMedi-AI credits. Creates a Stripe Checkout session and returns a checkoutUrl for you to open and complete payment in the browser — calling this tool charges nothing by itself. Specify amount (USD, min $1 = 1,000 credits) or package (starter $1, basic $5, standard $25, professional $100, enterprise $500). 1 credit = $0.001; credits are added automatically after checkout.

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

```json
"mcpServers": {
  "mymedi-ai-mcp-server": {
    "command": "npx",
    "args": ["-y","@mymedi-ai/mcp-server"]
  }
}
```

## Documentation

## What MyMedi-AI/mymedi-ai-mcp-server does

MyMedi-AI/mymedi-ai-mcp-server exposes healthcare billing and medical-data operations through MCP. Its coding coverage includes ICD-10-CM, CPT, and HCPCS records, with DMEPOS fee schedules, Medicare reimbursement values, code relationships, suggestions, and validation. Billing workflows cover prior-authorization requirements, face-to-face and written-order requirements, modifier guidance, denial-code explanations, claims checks, and supplier exposure reports.

The server also provides drug, provider, clinical-trial, disease-surveillance, and market data tools. Sources include CMS, OpenFDA, NIH RxNorm, ClinicalTrials.gov, NPPES, CMS Open Payments, CDC surveillance data, and the CodeReference database. Several tools add clearly labeled analysis or estimates to source data.

## How it works

Run the package with Node.js 20 or later using `npx -y @mymedi-ai/mcp-server`. MCP clients can connect through stdio. The hosted streamable HTTP endpoint is `https://mymedi-ai.com/mcp-stream`; Claude authenticates through its custom connector flow rather than requiring a copied API key.

Without credentials, six tools are available: prior-authorization list checks, denial-code explanations, basic code metadata, basic reimbursement, order-readiness checklists, and modifier guidance. These free tools are rate-limited to 60 requests per hour per IP. Other operations use an API key or connector sign-in and consume credits. Batch code operations charge per code and impose limits of 25 codes, while exposure reports allow up to 100 HCPCS codes.

## Setup and configuration

Install the package in an MCP client configuration and optionally set `MCP_API_KEY`. A key can be obtained by sending a registration request to the MyMedi-AI marketplace endpoint. `MYMEDI_API_KEY` is also accepted, but `MCP_API_KEY` takes precedence when both are set. New keys include starter credits, and the `buy_credits` tool returns a Stripe checkout link for adding more.

Claude Desktop, Cursor, VS Code, and Claude Code configurations use the package's npx command. Claude web users can add the hosted endpoint as a custom connector and complete the MyMedi-AI sign-in flow. A free demonstration endpoint provides basic code metadata and is limited to 60 requests per hour per IP.

## Tools and capabilities

- Look up, suggest, validate, batch-process, and cross-reference ICD-10, CPT, and HCPCS codes.
- Retrieve national professional-service reimbursement, DMEPOS rental and purchase ranges, or state-specific fee schedule values.
- Check prior-authorization, F2F/WOPD, SWO, modifier, denial, and documentation requirements.
- Predict prior-authorization outcomes only when a qualifying historical cohort exists; otherwise return verifiable CMS facts without fabricating a probability.
- Validate claims before submission and generate supplier-level exposure reports.
- Extract codes and dates from de-identified text, or scan text for common SSN, MRN, and birth-date patterns.
- Query drug, provider, payment, clinical-trial, surveillance, and healthcare-market datasets.

## Limitations and notes

The tools are designed for codes, modifiers, dates of service, facts, and de-identified text rather than patient identifiers. The compliance tool is a pattern-based scan, not a complete HIPAA audit, and the drug-interaction results represent statistical FAERS co-reporting signals rather than proof of interactions. Prior-authorization tools are scoped to Original Medicare fee-for-service; `pa_status` tracks requests entered in the MyMedi-AI workspace and does not query payers. Editorial modifier guidance is not payer policy, and claims validation does not determine medical necessity or prior authorization.

Paid calls consume credits. `compliance_audit` costs 250 credits and is intended for samples rather than every record. Calls for empty code-suggestion results, missing prior-authorization cohorts, and certain all-miss batch lookups are refunded according to the tool behavior.

_Full upstream README: https://allmcps.com/mcp/mymedi-ai-mymedi-ai-mcp-server/readme_