A
licenseNot graded
qualityC
maintenanceEnables querying Medicare payment amounts for physician services, lab tests, and DMEPOS items, plus daily unit limits and NCCI code-pair billing edits, with vintage- and locality-aware answers.
MIT
procedure-coverage
Server Details
Medicare coverage and fee-schedule amounts for CPT/HCPCS codes against a diagnosis
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- Status
- Healthy
- Last Tested
- Transport
- Streamable HTTP · MCP 2024-11-05
- URL
TDQS
A4.2/5.0
Scored across 1 tool
Disambiguation5/5
Only one tool exists, so there is no possibility of confusion with other tools. The tool's purpose is clearly scoped to Medicare procedure coverage lookups.
Naming Consistency4/5
With a single tool, there is no pattern to evaluate, but the name is descriptive and follows a clear domain_prefix_action convention. It would be higher if other tools existed to confirm consistency.
Tool Count2/5
A single tool for a domain as complex as Medicare procedure coverage feels extremely thin. Even a basic server would likely justify separate tools for coverage lookup, fee schedule lookup, or diagnosis-code validation.
Completeness3/5
The tool bundles coverage articles, ICD-10 lists, and fee schedule amounts into one operation, covering the core need. However, it lacks complementary operations like listing all covered codes for a diagnosis or retrieving local coverage article details independently, creating notable gaps.
Available Tools
1 toolmedicare_procedure_coverageAInspect
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.
ParametersJSON Schema
| Name | Required | Description | Default |
|---|---|---|---|
| codes | No | Comma-separated CPT/HCPCS codes, e.g. "27447,20610" | |
| diagnosis | No | ICD-10 code or prefix, e.g. "M17" (knee osteoarthritis) |
TDQS
A4.5/5.0
Behavior5/5
Does the description disclose side effects, auth requirements, rate limits, or destructive behavior?
There are no annotations, so the description carries the full burden, and it does this exceptionally well. It discloses exact sentinel behaviors for facility-only codes (not_applicable_in_this_setting), non-payable PFS statuses (not_payable_under_pfs), contractor-specific coverage, and the rule that a missing national rate is never treated as non-coverage. It also clarifies the amount is clinician fee only, excluding facility, device, or imaging fees.
Agents need to know what a tool does to the world before calling it. Descriptions should go beyond structured annotations to explain consequences.
Conciseness5/5
Is the description appropriately sized, front-loaded, and free of redundancy?
The main contract is front-loaded in the first sentence, and every subsequent sentence adds meaningful edge-case behavior rather than filler. The description is dense but still readable, and all distinctions—setting, PFS status, contractor specificity, fee scope—are explicitly justified.
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 no output schema and no annotations, the description thoroughly covers what the agent can expect back: article-level coverage data, ICD-10 lists, national PFS amounts, and special sentinel values. It also prevents common misinterpretations such as treating a missing national rate as non-coverage or treating the output as clinical guidance.
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 coverage for both parameters is 100%, so threed description is at baseline 3. It confirms `codes` means one or more CPT/HCPCS codes and that `diagnosis` is the ICD-10 value used for coverage matching, but this largely restates the schema descriptions. The additional detail about setting and PFS statuses pertains to return behavior rather than new parameter semantics.
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 names a specific verb ('report') and a precise resource: CMS Local Coverage Articles and the CMS Physician Fee Schedule PROFESSIONAL amount for given diagnosis and CPT/HCPCS codes. It clearly differentiates the tool's scope by specifying covered/non-covered ICD-10 diagnoses and fee-schedule payment status.
Agents choose between tools based on descriptions. A clear purpose with a specific verb and resource helps agents select the right tool.
Usage Guidelines4/5
Does the description explain when to use this tool, when not to, or what alternatives exist?
The description explains when the tool is applicable: for a diagnosis plus one or more CPT/HCPCS codes, and explicitly states what the tool is NOT for ('does NOT compare clinical effectiveness or recommend treatment'). No sibling tools exist, so it cannot name alternatives, but the boundary is nevertheless explicit enough for an agent to select it appropriately.
Agents often have multiple tools that could apply. Explicit usage guidance like "use X instead of Y when Z" prevents misuse.
Tool Schema Changelog
Recent tool additions, removals, and schema changes observed during successful MCP inspections.
1 tool update
- First observed
medicare_procedure_coverage
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