{
  "name": "medicare-fee-schedules-mcp",
  "title": "HealthMesh · Medicare Fee Schedules MCP",
  "version": "0.1.1",
  "description": "Medicare fee schedules from CMS's public files: Physician Fee Schedule RVUs, GPCIs, ZIP-to-locality mapping and payment calculation (CY 2026, October release), Clinical Laboratory Fee Schedule rates (2026-Q4), DMEPOS fee schedule amounts by state (2026-Q4) and IPPS MS-DRG relative weights and mean lengths of stay (FY 2026 and FY 2027).",
  "healthmesh_domain": "Claims & Payments",
  "datasets": [
    "CLM-05",
    "CLM-06",
    "CLM-08",
    "CLM-09"
  ],
  "mcp_endpoint": "https://medicare-fee-schedules.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/medicare-fee-schedules-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "CMS PFS Relative Value Files (RVU26D) + ZIP-locality file, CLFS 2026-Q4, DMEPOS 2026-Q4, IPPS Table 5 (FY 2026/2027)",
    "url": "https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files/rvu26d",
    "license": "U.S. Government work, public domain (CPT codes as identifiers only)",
    "refresh": "quarterly (bundled; GitHub Actions checks the CMS pages monthly)"
  },
  "tools": [
    {
      "name": "pfs_get_rvus",
      "title": "PFS relative value units and policy indicators",
      "description": "Returns the CY 2026 Medicare Physician Fee Schedule RVUs for a HCPCS/CPT code (+ optional modifier 26/TC/53): work, non-facility and facility practice expense, malpractice, totals, status code, global days, PC/TC, multiple-procedure, bilateral, assistant/co/team surgery indicators and both 2026 conversion factors. Without a modifier it returns the global row and lists other modifier rows (26/TC)."
    },
    {
      "name": "pfs_calculate_payment",
      "title": "Calculate the Medicare PFS payment in a locality",
      "description": "Calculates the CY 2026 Medicare Physician Fee Schedule allowed amount for a code (+ modifier) in a payment locality (by MAC-locality or ZIP): (work RVU x work GPCI + PE RVU x PE GPCI + MP RVU x MP GPCI) x CF, for non-facility and facility settings, with both 2026 conversion factors (non-QP and QP) and the OPPS cap for imaging where it applies. Returns the formula and inputs."
    },
    {
      "name": "pfs_lookup_locality",
      "title": "Find the Medicare PFS locality and GPCIs",
      "description": "Maps a ZIP code to its Medicare PFS MAC/locality (CMS ZIP5 file, with rural/super-rural flag) and returns the CY 2026 GPCIs (work with 1.0 floor, PE, MP) and the counties in the locality; or lists all localities of a state; or returns one MAC-locality."
    },
    {
      "name": "ipps_get_drg_weight",
      "title": "IPPS MS-DRG relative weight and length of stay",
      "description": "Returns the Medicare IPPS MS-DRG title, MDC, type (MED/SURG), relative weight, geometric and arithmetic mean length of stay and post-acute transfer / special pay flags from IPPS Table 5 for FY 2026 or FY 2027 (default: the fiscal year in effect today; FY starts October 1)."
    },
    {
      "name": "clfs_get_rate",
      "title": "Clinical Laboratory Fee Schedule rate",
      "description": "Returns the 2026-Q4 Medicare Clinical Laboratory Fee Schedule national limitation amount for a lab code (CPT, PLA or HCPCS Level II), with modifier rows (e.g. QW CLIA-waived), indicator and effective date. Descriptors are returned only for HCPCS Level II codes."
    },
    {
      "name": "dmepos_get_fee",
      "title": "DMEPOS fee schedule amount",
      "description": "Returns the 2026-Q4 Medicare DMEPOS fee schedule amounts for a HCPCS code in a state: non-rural and rural fee for each modifier combination (e.g. NU purchase new, RR rental, UE used, KU/KF), ceiling and floor, payment category and DME MAC/Part B jurisdiction, with the CMS HCPCS description."
    },
    {
      "name": "fee_schedules_describe_dataset",
      "title": "Describe the fee schedule data",
      "description": "Explains which CMS fee schedule files are loaded (releases, quarters, row counts, conversion factors), how amounts are calculated, the licensed-text policy and what is not covered (OPPS/ASC rates, IPPS hospital-level payment, site-of-service comparison)."
    }
  ]
}