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Medicare Physician Payment

medicare_physician_payment
Read-onlyIdempotent

What does Medicare pay a doctor for a procedure code, in a specific place? Returns the relative value units (work, practice expense, malpractice) and the actual dollar payment for a HCPCS/CPT code, adjusted for the Medicare LOCALITY — payment varies geographically, not just by state. Answers "how much does Medicare pay for 99213", "what is code 27130 worth in Los Angeles", "reimbursement rate for an office visit in Texas", and fee-schedule or contract-rate benchmarking. Gives both the facility and non-facility amount (a procedure pays less in a hospital, because the hospital bills the overhead separately), the global period, and the status code saying whether the code is separately payable at all. States the fee-schedule YEAR and the locality it resolved to on every response, because a rate quoted for the wrong year or locality is a wrong number. Sourced from the CMS Physician Fee Schedule relative value files.

Input Schema

TableJSON Schema
NameRequiredDescriptionDefault
codeYesHCPCS or CPT code, e.g. "99213" (office visit) or "27130" (hip replacement).
yearNoFee-schedule year, e.g. 2026. Omit to use the newest loaded year, which is stated in the response.
localityNoWhere the service is provided — a state code ("CA"), state name, or Medicare locality name ("Bakersfield", "Manhattan"). Payment varies by locality; omit only if you want the national picture.
modifierNoOptional HCPCS modifier, e.g. "26" (professional component) or "TC" (technical component).

Schema Changelog

Changes observed during successful MCP inspections.

  1. First observed

TDQS

A4.2/5.0
Behavior4/5

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

Annotations already declare readOnlyHint, idempotentHint, non-destructive, and openWorldHint, so the safety profile is covered. The description adds behavioural substance the annotations don't: it returns both facility and non-facility amounts, the global period, the status code, and always states the resolved year and locality because a rate for the wrong year/locality is misleading. It does not mention any rate limits or failure modes.

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-loads the core question and then progressively adds the return payload, facility/non-facility nuance, and year/locality caveat. It is a single dense paragraph rather than a tautology, though it is somewhat long and could have been split. Every sentence carries operational content.

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, the description enumerates the return payload (work/practice expense/malpractice RVUs, dollar amount, facility and non-facility figures, global period, status code) and the guarantee that year and locality are always echoed. That covers everything an agent needs to interpret a response, and the caveat about wrong year/locality is exactly the guidance that prevents misuse.

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 code, year, locality, and modifier. The description reinforces semantics (locality is geographic and payment varies by locality, not just state; year omission defaults to newest loaded year; facility vs non-facility distinction) but adds only marginal detail beyond what the schema provides. Baseline 3 is appropriate.

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 (what Medicare pays for a procedure code, in a place) and names the exact resource (RVUs plus dollar payment from the CMS Physician Fee Schedule). It distinguishes itself from siblings like medicare_dmepos_rate, medicare_lab_rate, and medicare_pricing_coverage by scoping to physician fee schedule payments and locality. An agent can tell this is the physician/procedure reimbursement tool.

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?

Provides concrete trigger phrasings ('how much does Medicare pay for 99213', 'what is code 27130 worth in Los Angeles', 'reimbursement rate for an office visit in Texas') and frames it as fee-schedule/contract-rate benchmarking, so usage context is clear. It does not explicitly exclude cases better suited to siblings (e.g. DMEPOS or lab rate tools), but the domain restriction is apparent.

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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