mcp-medicare-coverage

MCP server for Medicare Coverage

Part of Pipeworx — an MCP gateway connecting AI agents to 1476+ live data sources.

Tools

Tool	Description
`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 product or therapy name ("CAR T-cell", "amyloid PET", "insulin pump"), by title, benefit category, or NCD number. NCDs describe national Medicare policy; they are not individualized coverage guarantees or medical advice.
`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 number such as CAG-00450N, an LCD number such as L34246 — or CMS's internal numeric document id. Public identifiers are resolved to the internal id automatically, and every response reports the resolved internal document_id alongside the public document_display_id and the document title so a caller can confirm the policy matches the one they asked about. LCD revision history requires a caller-supplied CMS license token. Timeline entries describe policy publication and revision history; utilization, payment, and claim-level adjudication come from other tools.
`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 trend. For a plain coverage question with no codes in hand, medicare_ncd_search answers it directly. CMS does not validate the product-to-code association; verify coding and policy details independently.
`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 spending. Spending is gross, before confidential manufacturer rebates.
`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.

Quick Start

Add to your MCP client (Claude Desktop, Cursor, Windsurf, etc.):

config.json

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

What this endpoint actually serves

tools/list at https://gateway.pipeworx.io/medicare-coverage/mcp returns the tools in the table above plus the shared Pipeworx meta-tools — ask_pipeworx, discover_tools, search_within, remember/recall and the rest of the gateway-wide set. So the tool count you see is larger than this table: a single-pack endpoint currently lists roughly 30 shared tools alongside the pack's own. The connection's initialize response states its exact scope, and is the authoritative answer for a given day.

This is deliberate, not multiplexing by accident. The meta-tools are what let a scoped connection answer a question this pack does not cover — via ask_pipeworx, which routes across the whole catalog — without you adding a second MCP server. There is currently no way to mount a pack endpoint without them; if the extra schemas cost you more context than the routing is worth, connect to the full gateway once rather than to several pack endpoints.

Or connect to the full Pipeworx gateway to get every pack's tools listed directly, instead of just this one's:

config.json

{
  "mcpServers": {
    "pipeworx": {
      "url": "https://gateway.pipeworx.io/mcp"
    }
  }
}

Both URLs reach the same gateway and the same 1476+ data sources. The only difference is which pack's tools are listed directly; ask_pipeworx reaches all of them from either one.

Using with ask_pipeworx

Instead of calling tools directly, you can ask questions in plain English — this works on the pack endpoint above as well as on the full gateway:

Code

ask_pipeworx({ question: "your question about Medicare Coverage data" })

The gateway picks the right tool and fills the arguments automatically.

License

MIT

Medicare Coverage README