procedure-coverage
Medicare coverage and fee-schedule amounts for CPT/HCPCS codes against a diagnosis
Should I use this
Quality & Safety
Based on automated analysis of tool definitions and protocol compliance.
Context Cost
This is the approximate number of tokens consumed each time the server's tools are loaded into a model's context. Higher counts reduce the attention available for other tasks.
Install
One-Click Install
Add this to your `claude_desktop_config.json` file:
{
"mcpServers": {
"procedure-coverage": {
"url": "https://medicalclaim.ai/mcp"
}
}
}Remote endpoints
https://medicalclaim.ai/mcpstreamable-httpWhat it can do
Tool inventory
Tools (1)
🟢medicare_procedure_coverage(diagnosis, codes)
For a diagnosis and one or more CPT/HCPCS codes, report what CMS Local Coverage Articles record for each code, which ICD-10 diagnoses those articles list as covered or non-covered, and the CMS Physician Fee Schedule PROFESSIONAL amount where a national rate exists. Setting matters and is stated: codes performed only in a facility return not_applicable_in_this_setting rather than an invented office price, and codes CMS does not pay under the PFS (status I, X, N, E, B, P) return not_payable_under_pfs rather than a figure computed from published RVUs. Coverage is contractor-specific. Does NOT compare clinical effectiveness or recommend treatment, and a missing national rate is never treated as non-coverage. The amount is the clinician fee only — not the facility fee, device or imaging.
Input Schema
{
"type": "object",
"properties": {
"diagnosis": {
"type": "string",
"description": "ICD-10 code or prefix, e.g. \"M17\" (knee osteoarthritis)"
},
"codes": {
"type": "string",
"description": "Comma-separated CPT/HCPCS codes, e.g. \"27447,20610\""
}
},
"required": []
}Community
Evidence