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

**Category:** Biology, Medicine and Bioinformatics  
**Repository:** https://github.com/MyMedi-AI/mymedi-ai-mcp-server  
**GitHub Stars:** 2  
**npm Downloads (last month):** 423  
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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 81K-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. Returns current status, dates, and expiration info.
- **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 named entities from clinical text. Identifies ICD-10 codes, CPT codes, dates, medications, and 12 entity types with confidence scores.
- **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** — HIPAA compliance audit. Scans data for PHI exposure (SSN, MRN, DOB patterns), returns findings with severity, score (0-100), and remediation recommendations.
- **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 MCP server does

The MyMedi-AI/mymedi-ai-mcp-server MCP server gives compatible AI clients access to healthcare billing and clinical-information operations. Its tools cover ICD-10, CPT, and HCPCS lookup; code suggestions and validation; Medicare reimbursement; DMEPOS fee schedules; prior authorization; claims validation; medical named-entity extraction; and HIPAA-oriented data checks.

The catalog also includes drug lookup and interaction signals, RxNorm terminology, clinical-trial search, disease surveillance, NPI provider search, provider enrichment, Sunshine Act payment data, and state-level healthcare market analysis. CMS, OpenFDA, NIH RxNorm, ClinicalTrials.gov, CDC, and CMS Open Payments are identified as public or government data sources for relevant tools.

## How it works

The server can be used as a hosted Streamable HTTP MCP endpoint at `https://mymedi-ai.com/mcp-stream`, or run locally through the npm package with `npx`. Claude, Cursor, VS Code, and other MCP clients can connect to it. The README also provides MCP prompts for denial decoding, order-readiness checks, claim scrubbing, appeal drafting, and reimbursement estimation, plus dataset resources for CMS prior-authorization and F2F/WOPD lists.

Six tools are available without an API key: prior-authorization requirement checks, denial-code explanations, basic code lookup, basic reimbursement, DMEPOS order-readiness checklists, and modifier guidance. These free tools are rate-limited to 60 requests per hour per IP. Other tools require an API key and consume credits, with prices varying by operation. Batch lookup, validation, and exposure-report tools charge per code and impose documented maximum batch sizes.

## Setup and configuration

For a local MCP client, configure the package as `npx -y @mymedi-ai/mcp-server`. Set `MCP_API_KEY` to use the account-based tools; leaving it unset limits use to the free tools. `MCP_API_BASE_URL` changes the API base URL from its default of `https://mymedi-ai.com`. `MCP_CONNECTOR_TOKEN` is available for shared-egress rate limiting in hosted, multi-user deployments and is not needed for individual installations.

Accounts can be registered with the platform registration endpoint to receive starter credits. Additional credits can be purchased through Stripe. The hosted Claude connection does not require authentication for the free tools.

## Tools and capabilities

- Look up, suggest, validate, batch-process, and cross-reference ICD-10, CPT, and HCPCS codes.
- Retrieve Medicare PFS, OPPS, and DMEPOS payment information, including state-specific fee schedules where supported.
- Check prior-authorization requirements, estimate approval outlook from historical cohorts, inspect request status, and map supplier catalogs against CMS requirement lists.
- Validate claims, extract medical entities, audit text for PHI patterns, and provide DMEPOS modifier or order-readiness guidance.
- Search drug, provider, clinical-trial, disease-surveillance, payment, and healthcare-market data.

## Limitations and notes

The MyMedi-AI/mymedi-ai-mcp-server MCP server is read-only and described as PHI-free by design, but its documentation specifically warns that patient data should not be sent to the order-readiness tool. Prior-authorization features are scoped to Original Medicare fee-for-service. Modifier guidance is editorial content rather than payer policy, and prior-authorization prediction reports no probability when an adequate historical cohort is unavailable.

Paid calls require credits and may be refunded on specified no-match or no-cohort paths. Batch operations have maximum sizes, and free access is rate-limited. Results should therefore be checked against the applicable payer rules, dates of service, and operational requirements before use in billing or clinical workflows.

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