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Medicare Fee Schedule Rates

Medicare physician fee lookup

medicare_get_physician_fee
Read-onlyIdempotent

Use this when you need what Medicare's Physician Fee Schedule allows for a CPT or HCPCS code on a given date of service, for the nation or for one state or locality, in the office or facility setting. It takes up to 25 lines (code, modifier, date of service) and returns one answer per line, in order: CMS's allowed amount (national figure, plus the state range or one locality's figure when a state is given), the CMS release in force on that date, its source files with SHA-256 checksums, and the release catalog URL. It covers dates of service from Jan 1, 2023 through Dec 31, 2026; each date is priced under the quarterly CMS release in force that day, and a date outside that span gets a reason instead of a figure. A code with no national rate on this schedule (bundled, carrier-priced, laboratory, drug, anesthesia, ambulance, supplies, or absent from that release) returns a result_kind and a reason, not an error, and a malformed line returns an error for that line only. Do not use it for hospital outpatient or inpatient facility payments, ambulatory surgery center fees, Medicaid, commercial or workers' compensation rates, CPT code descriptions, or opinions on whether a charge is reasonable. It is read-only; amounts are Medicare-allowed amounts per unit, before sequestration and multiple-procedure reductions.

Input Schema

NameRequiredDescriptionDefault
linesYesOne to 25 service lines to price. The answers come back in this order.
stateNoOptional, applies to every line. Two-letter key or full name of a state, DC, Puerto Rico or the Virgin Islands. Leave it out for the national figure only. Example: NJ.
detailNoOptional, applies to every line. concise (default) returns the national figure and the state range. detailed lists every locality in the state, with the geographic indexes used, and needs state.
settingNoOptional, applies to every line. Which setting the headline figure reports: office (non-facility) or facility (hospital). Both settings are always in the figures. Leave it out for the setting CMS shows first.
localityNoOptional, applies to every line, needs state. CMS locality number inside that state. Leave it out to get the state's range. Example: 01.

Output Schema

NameRequiredDescriptionDefault
noticeYes
schemaYes
resultsYes
coverageYes
releasesYes
ama_noticeYes
recipe_formulaYes
release_catalog_urlYes

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.6/5.0
Behavior5/5

Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?

Annotations already cover safety (readOnly, idempotent, non-destructive), and the description adds substantial behavioral context beyond them: the Jan 1 2023–Dec 31 2026 coverage window, quarterly-release pricing per date, out-of-span dates returning a reason rather than a figure, unpriced code categories returning result_kind/reason instead of an error, per-line malformed errors, and that amounts precede sequestration/multiple-procedure reductions.

Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.

Conciseness4/5

Is the description appropriately sized, front-loaded, and free of redundancy?

The dense block is front-loaded with the use case and each sentence conveys distinct, non-redundant information (coverage dates, per-line error behavior, exclusions). It is long, but nearly every clause earns its place; only marginal tightening would help.

Shorter descriptions cost fewer tokens and are easier for agents to parse. Every sentence should earn its place.

Completeness5/5

Given the tool's complexity, does the description cover enough for an agent to succeed on first attempt?

Given a 5-parameter tool with nested line objects, rich annotations, and an output schema, the description supplies everything an agent needs: coverage span, degradation behavior, exclusions, and the meaning of the returned figures. No material gap remains for correct invocation.

Complex tools with many parameters or behaviors need more documentation. Simple tools need less. This dimension scales expectations accordingly.

Parameters3/5

Does the description clarify parameter syntax, constraints, interactions, or defaults beyond what the schema provides?

Schema description coverage is 100%, so the schema already fully documents code, modifier, date, state, detail, setting, and locality (including the 'needs state' dependencies). The description restates the line count and national/state/locality scope, adding only mild reinforcing context rather than new semantics, so the baseline 3 applies.

Input schemas describe structure but not intent. Descriptions should explain non-obvious parameter relationships and valid value ranges.

Purpose5/5

Does the description clearly state what the tool does and how it differs from similar tools?

The description opens with a precise verb+resource+scope: it returns what Medicare's Physician Fee Schedule allows for a CPT/HCPCS code on a given date, nationally or by state/locality, in office or facility setting. This is specific enough that an agent can distinguish it from medicare_list_fee_releases (which lists releases) without opening the schema.

Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.

Usage Guidelines5/5

Does the description explain when to use this tool, when not to, or what alternatives exist?

It explicitly states when to use it and then enumerates a comprehensive when-NOT list: hospital outpatient/inpatient payments, ASC fees, Medicaid, commercial/workers' comp rates, CPT descriptions, and reasonableness opinions. The exclusions are strong enough to route the agent correctly even though the sibling is not named by name.

Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.

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