Click on "Deploy Server".
Wait a few minutes for the server to deploy. Once ready, it will show a "Started" state.
In the chat, type @ followed by the MCP server name and your instructions, e.g., "@Medical Billing MCP What does denial code CO-50 mean and how to fix it?"
That's it! The server will respond to your query, and you can continue using it as needed.
Here is a step-by-step guide with screenshots.
Open-source billing knowledge for AI assistants
The Problem: A billing staff member gets a denial code. They Google it, read 5 articles, call the payer, wait on hold for 45 minutes, and maybe get an answer. Cost: 30-60 minutes per denial.
The Solution: Ask an AI assistant. Get instant answers with resolution steps. Cost: 2 minutes.
An MCP (Model Context Protocol) server that gives AI assistants like Claude access to medical billing knowledge:
Tool | What It Does |
| Look up diagnosis codes |
| Look up procedure codes |
| Understand when to use modifiers (25, 59, etc.) |
| Understand denial codes + how to fix them |
| Get payer-specific rules (timely filing, etc.) |
| Check if codes are bundled together |
This is a knowledge layer. You bring your own payer connectivity (Stedi, Availity, Change Healthcare, etc.).
Related MCP server: MCP Healthcare Server
# Clone the repo
git clone https://github.com/Kustode-ce/medical-billing-mcp.git
cd medical-billing-mcp
# Run with Docker
docker compose up -d
# Test it
docker compose exec mcp python -m medical_billing_mcp --test# Clone and install
git clone https://github.com/Kustode-ce/medical-billing-mcp.git
cd medical-billing-mcp
pip install -e .
# Run the server
python -m medical_billing_mcpAdd to your claude_desktop_config.json:
{
"mcpServers": {
"medical-billing": {
"command": "python",
"args": ["-m", "medical_billing_mcp"]
}
}
}Config locations:
macOS: ~/Library/Application Support/Claude/claude_desktop_config.json
Windows: %APPDATA%\Claude\claude_desktop_config.json
Linux: ~/.config/Claude/claude_desktop_config.json
Restart Claude Desktop.
Once installed, ask Claude questions like:
"What does ICD-10 code E11.9 mean?"
"What's CPT code 99214 and what documentation do I need?"
"When should I use modifier 25?"
"I got denial code CO-50. What does it mean and how do I fix it?"
"My claim was denied for 'not medically necessary'. What are the resolution steps?"
"What's Medicare's timely filing limit?"
"What are Blue Cross MA's known billing issues?"
"Are CPT codes 99213 and 36415 bundled?"
See docs/examples/ for sample conversations.
┌─────────────────────────────────────────────────────────────────┐
│ AI ASSISTANT (Claude) │
└─────────────────────────────────────────────────────────────────┘
│
│ MCP Protocol
▼
┌─────────────────────────────────────────────────────────────────┐
│ MEDICAL BILLING MCP │
│ │
│ ┌──────────────────────────────────────────────────────────┐ │
│ │ server.py │ │
│ │ (Tool definitions + routing) │ │
│ └──────────────────────────────────────────────────────────┘ │
│ │ │
│ ┌──────────────────────────────────────────────────────────┐ │
│ │ handlers.py │ │
│ │ (Lookup functions) │ │
│ └──────────────────────────────────────────────────────────┘ │
│ │ │
│ ┌──────────────────────────────────────────────────────────┐ │
│ │ data/ │ │
│ │ │ │
│ │ icd10.json cpt.json modifiers.json │ │
│ │ denials.json payers.json bundling.json │ │
│ │ │ │
│ │ [Community contributes here] │ │
│ └──────────────────────────────────────────────────────────┘ │
└─────────────────────────────────────────────────────────────────┘See ARCHITECTURE.md for detailed design documentation.
Not In Scope | Why | You Already Have |
Claim submission | Not our job | Stedi, Availity |
Eligibility checks | Real-time payer data | Stedi, payer portals |
Prior auth submission | Payer integration | Cohere, eviCore |
EOB/ERA parsing | Clearinghouse function | Stedi, clearinghouse |
PHI storage | Security/compliance | Your EHR/PMS |
We provide knowledge. You provide connectivity.
All data is from public sources:
Data | Source |
ICD-10 codes | CMS |
CPT descriptions | AMA (limited - full requires license) |
HCPCS codes | CMS |
Denial codes (CARC/RARC) | X12 / Washington Publishing |
Payer rules | Public payer manuals |
We welcome contributions! The easiest way to help:
Know a payer's quirks? Edit data/payers.json:
{
"bcbs_tx": {
"name": "Blue Cross Blue Shield Texas",
"timely_filing_days": 95,
"known_issues": ["Requires modifier 25 documentation"]
}
}Fixed a tricky denial? Share how in data/denials.json:
{
"CO-151": {
"description": "Service not covered",
"resolution_steps": [
"Check if service requires prior auth",
"Verify correct place of service code",
"Appeal with medical necessity documentation"
]
}
}See CONTRIBUTING.md for full guidelines.
medical-billing-mcp/
├── src/medical_billing_mcp/
│ ├── __init__.py
│ ├── __main__.py
│ ├── server.py # MCP server
│ ├── handlers.py # Lookup functions
│ └── data/ # JSON knowledge base
│ ├── icd10.json
│ ├── cpt.json
│ ├── modifiers.json
│ ├── denials.json
│ ├── payers.json
│ └── bundling.json
├── tests/
├── docs/
│ ├── diagrams/ # Architecture diagrams
│ ├── api/ # API documentation
│ └── examples/ # Usage examples
├── docker/
│ ├── Dockerfile
│ └── docker-compose.yml
├── ARCHITECTURE.md
├── CONTRIBUTING.md
├── LICENSE
└── README.mdMIT License - see LICENSE
Note: CPT codes are copyrighted by the AMA. This tool provides limited descriptions for educational purposes. For full CPT data, obtain an AMA license.
🐛 Issues: GitHub Issues
💬 Discussions: GitHub Discussions
Made for the healthcare community ❤️
Because providers should spend time with patients, not fighting insurance companies.
Check if procedure codes are bundled together
Inputs: codes (required).
Look up CPT procedure codes by code or search term
Inputs: code, search.
Look up denial codes (CARC/RARC) with resolution steps
Inputs: code, search.
Look up ICD-10 diagnosis codes by code or search term
Inputs: code, search.
Look up billing modifier usage and documentation requirements
Inputs: modifier (required).
Look up payer-specific billing rules
Inputs: payer (required).
Recent tool additions, removals, and schema changes observed during successful MCP inspections.
Loading tool schema changelog…
Scored across 6 tools
Each tool targets a distinct category of medical billing data (CPT, ICD-10, modifiers, bundling, denials, payer rules), with no overlap or ambiguity.
All tools follow the consistent 'lookup_<entity>' pattern using snake_case, making predictable and easy to understand.
6 tools cover the major lookup types for medical billing without being overly numerous or sparse, a well-scoped set.
Core billing lookups (CPT, ICD-10, modifiers, bundling, denials, payer rules) are covered; missing HCPCS or other minor codes are not critical for most scenarios.
Telehealth support for Claude, Codex and Cursor: investigate cases and connect your tools.
Medical RAG: semantic search for clinical guidelines, drug interactions, diagnoses & EHR data.
Medical RAG: semantic search for clinical guidelines, drug interactions, diagnoses & EHR data.
Connect your team's living knowledge base — docs, data, issues, CRM — to Claude and ChatGPT.
