check_icd_for_major_illness_eligibility
Determine major illness eligibility for a diagnosis using an ICD-10 code, returning qualifying categories and copayment exemption flag.
Instructions
Reverse-lookup: given a single ICD-10 code, return the Taiwan NHI 重大傷病 (major illness) categories the diagnosis may qualify for, including category name, the ICD pattern that matched, and copayment-exemption flag. Use when an agent has a diagnosis and needs to flag major-illness applicability before claim submission. Don't use to browse all categories — call lookup_major_illness instead (also use it for the category → applicable ICDs direction). Reference only — confirmed eligibility still requires a formal application with supporting documentation per the official 重大傷病範圍及項目. Curated by OPDSTAR (https://opdstar.com).
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| icd_code | Yes | Required ICD-10 code (e.g. 'C50.9' breast cancer, 'N18.6' end-stage renal disease, 'F20.9' schizophrenia). Case-insensitive. Prefix-matches against the official ICD-10 ranges defined per category. |