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Medicare Lab Rate

medicare_lab_rate
Read-onlyIdempotent

What does Medicare pay for a laboratory test? Returns the national Clinical Laboratory Fee Schedule rate for a lab HCPCS/CPT code — lab tests are paid from their own national fee schedule rather than the physician schedule, so there is one rate and no locality adjustment. Answers "how much does Medicare pay for a comprehensive metabolic panel", "CLFS rate for 80053", "what does a lipid panel reimburse". States the year and quarter of the schedule used, since lab rates are republished quarterly. Sourced from the CMS Clinical Laboratory Fee Schedule.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
codeYesLab HCPCS/CPT code, e.g. "80053" (comprehensive metabolic panel) or "85025" (complete blood count).
yearNoSchedule year. Omit for the newest loaded, which is stated in the response.

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.1/5.0
Behavior4/5

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

Annotations already cover the read-only, idempotent, non-destructive profile, so the bar is lower. The description adds real context beyond them: the rate is national with no locality adjustment, schedules are republished quarterly, the response states the year and quarter used, and the data source is the CMS CLFS.

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?

Front-loaded with the core question, then scope, then sourcing. Three paraphrased example queries are slightly redundant but each reinforces the intended invocation.

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

Completeness4/5

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

With no output schema, the description usefully signals what comes back (a rate plus the schedule year and quarter). Combined with annotations and full schema coverage, an agent has nearly everything needed; only an explicit note on error handling for unknown codes is missing.

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 documents both parameters including the omit-for-newest behavior of year. The description adds no syntax or format detail beyond the schema, so the baseline of 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?

States a specific question the tool answers and a precise resource: the national Clinical Laboratory Fee Schedule rate for a lab HCPCS/CPT code. It distinguishes itself from the physician-schedule sibling by explaining that lab tests are paid from their own national fee schedule with no locality adjustment.

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?

Supplies concrete triggering queries ("how much does Medicare pay for a comprehensive metabolic panel", "CLFS rate for 80053") and clarifies the schedule distinction that separates it from medicare_physician_payment. It does not name alternative sibling tools explicitly or state exclusions, so it falls short of a 5.

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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