MCP server

Medicare Pricing

io.github.pipeworx-io/medicare-pricing

Checked 26 Oct 2026, 08:29 UTC · Connected to it and listed its tools

What does Medicare PAY — physician fee schedule, lab rates, and per-day unit limits.

Website Source

At a glance

Type

MCP server

Publisher

pipeworx.io (verified by the MCP Registry)

Status

Working at last check

Tools

54

Token cost

About 31,311 tokens per request

Sets up in

Claude Code, Claude Desktop, Codex, Gemini CLI, Cursor, VS Code, Antigravity, ChatGPT, OpenAI API, Grok

Last checked

26 Oct 2026, 08:29 UTC

Connect it to your agent

Add to CursorAdd to VS CodeVS Code Insiders

Opens the app, which shows the server and asks you to confirm. For other apps, copy the setup below.

Claude Code

claude mcp add --transport http medicare-pricing https://gateway.pipeworx.io/medicare-pricing/mcp

Claude Desktop

Settings → Connectors → Add custom connector, and paste the URL.

Codex (config.toml)

[mcp_servers.medicare-pricing]
url = "https://gateway.pipeworx.io/medicare-pricing/mcp"

Gemini CLI

{"mcpServers":{"medicare-pricing":{"httpUrl":"https://gateway.pipeworx.io/medicare-pricing/mcp"}}}

Cursor

{"mcpServers":{"medicare-pricing":{"url":"https://gateway.pipeworx.io/medicare-pricing/mcp"}}}

VS Code

{"servers":{"medicare-pricing":{"type":"http","url":"https://gateway.pipeworx.io/medicare-pricing/mcp"}}}

Antigravity

agy mcp add medicare-pricing https://gateway.pipeworx.io/medicare-pricing/mcp

ChatGPT

Settings → Apps & Connectors → Advanced settings: turn on Developer mode, then Create a connector and paste the URL. Which plans can do this varies.

OpenAI API (Responses tools)

{"type":"mcp","server_label":"medicare-pricing","server_url":"https://gateway.pipeworx.io/medicare-pricing/mcp","require_approval":"always"}

Grok (xAI API tools)

{"type":"mcp","server_label":"medicare-pricing","server_url":"https://gateway.pipeworx.io/medicare-pricing/mcp"}

Tools

• check_code_pair ~360 tokens
  Can two procedure codes be billed together on the same day? Checks the CMS National Correct Coding Initiative procedure-to-procedure (PTP) edit for a pair of HCPCS/CPT codes and returns the modifier indicator saying whether the pair can never be unbundled, can be unbundled with an appropriate modifi
• explain_ncci_edit ~318 tokens
  What NCCI procedure-to-procedure edits exist for a single code? Lists the other codes this HCPCS/CPT code has a recorded PTP edit with — whether it is the code you bill (Column 1) or the one bundled into another (Column 2) — with each pair's modifier indicator. Answers "what codes conflict with 9921
• medicare_code_units_limit ~302 tokens
  How many units of a procedure code will Medicare pay for one patient in one day? Returns the NCCI Medically Unlikely Edit (MUE) — the maximum units allowed — with the adjudication indicator saying whether the limit is absolute or can be overridden with documentation, and the rationale for it. Answer
• medicare_dmepos_rate ~649 tokens
  What does Medicare pay for a piece of durable medical equipment, prosthetic, orthotic, or medical supply (DMEPOS)? Returns the fee-schedule amount for a HCPCS Level II code (E/K/L/A-codes — CPAP machines, wheelchairs, ostomy supplies, braces, oxygen equipment...) in a given US state, with SEPARATE r
• medicare_fqhc_gaf ~447 tokens
  What is the FQHC Geographic Adjustment Factor (GAF) for a place, and what does Medicare pay a Federally Qualified Health Center per visit THERE? Returns the official CMS FQHC PPS GAF for a Medicare locality and calendar year, and the GAF-adjusted per-visit rate (national base rate x GAF). Answers "F
• medicare_fqhc_pps_rate ~356 tokens
  What does Medicare pay a Federally Qualified Health Center (FQHC) per visit? Returns the CMS FQHC Prospective Payment System (PPS) national BASE payment rate for a calendar year — the figure CMS publishes once a year, before any per-FQHC Geographic Adjustment Factor (GAF) is applied. Answers "what i
• medicare_gpci_lookup ~505 tokens
  What are the Medicare geographic adjustment indices (GPCIs) for a place — with NO procedure code needed? Returns the work, practice-expense and malpractice GPCI for a Medicare payment locality (or every locality in a state), for a calendar year. Answers "GPCI for Rest of Florida locality 99", "Medic
• medicare_lab_rate ~276 tokens
  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 Medi
• medicare_lab_test_lookup ~514 tokens
  Resolve a branded molecular or genomic lab test by its commercial name (e.g. Signatera, Guardant360 CDx, FoundationOne CDx, FoundationOne Liquid CDx, Tempus xT CDx, DecisionDx-Melanoma, Envisia, Shield) to its CPT PLA / HCPCS billing code, the lab that runs it, what Medicare pays for it now on the C
• medicare_opps_rate ~603 tokens
  What does Medicare pay a HOSPITAL OUTPATIENT department for a procedure, device, or drug code? Returns the status indicator, Ambulatory Payment Classification (APC), relative weight, national payment rate, and beneficiary copayment for a HCPCS/CPT code under the Hospital Outpatient Prospective Payme
• medicare_physician_payment ~514 tokens
  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 mu
• medicare_pricing_coverage ~164 tokens
  What Medicare pricing data is loaded and how current it is: the fee-schedule years and quarters held, how many codes are in each dataset, how many localities, and the PTP pair-edit change window. Use to check a vintage is current enough to quote before relying on a rate, and to see the scope limit o

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