Medicare Coverage

Retrieve one CMS Medicare Coverage Article with its CPT/HCPCS codes and contractor records. Licensed AMA/ADA/AHA content requires a caller-provided CMS license token. Code inclusion describes billing guidance, not guaranteed coverage or payment.

List CMS Coverage API state identifiers used to scope local Medicare coverage searches.

Retrieve official CMS version or revision history for a Medicare NCD, NCA, CAL, or LCD. Accepts either identifier CMS publishes for a coverage document: the public one that appears in the policy text and in every citation of it — an NCD section number such as 310.1 or 90.2, an NCA/CAL tracking number such as CAG-00450N, an LCD number such as L34246 — or CMS's internal numeric document id. Public identifiers are resolved to the internal id automatically, and every response reports the resolved internal document_id alongside the public document_display_id and the document title so a caller can confirm the policy matches the one they asked about. LCD revision history requires a caller-supplied CMS license token. Timeline entries describe policy publication and revision history; utilization, payment, and claim-level adjudication come from other tools.

Show annual national Medicare fee-for-service DME supplier, beneficiary, claim, service, and average-payment metrics for one HCPCS code. It excludes Medicare Advantage and is not total market demand or company revenue.

Return a bounded API-order sample of Medicare fee-for-service DME supplier rows for an exact HCPCS code and year, optionally filtered by state, with the authoritative matching-row count. This is not a supplier ranking or total market size.

Show annual Medicare enrollment and Medicare Advantage/other, Original Medicare, Part D PDP, Part D MA-PD, and dual-eligible counts nationally or for one state. Enrollment counts are program participation, not utilization or revenue.

Compare state-level Medicare fee-for-service provider, beneficiary, service, and average-payment metrics for one HCPCS code and program year. State beneficiary counts across places of service must not be summed as unique people.

Show annual Medicare Physician & Other Practitioners national utilization and payment metrics for one HCPCS code. Claims are fee-for-service aggregates with suppression and methodology limits; they do not measure total US use, coverage, demand, or company revenue.

Show annual national Medicare fee-for-service utilization and average-payment trends for one inpatient MS-DRG or outpatient APC using CMS geography/service aggregates. Trends exclude Medicare Advantage and do not measure total market demand, revenue, or profitability.

Return a bounded sample of hospital-level Medicare fee-for-service inpatient rows for an exact MS-DRG and year, optionally filtered by state, with the authoritative matching-row count. Average payments are not hospital revenue or margin.

Retrieve one Medicare LCD by document ID and version. Detailed LCD text requires a CMS license-agreement bearer token because documents may contain licensed AMA/ADA/AHA material; pass _licenseToken obtained directly from CMS after accepting those terms.

Search current final Medicare Local Coverage Determinations (LCDs), optionally restricted to a state. LCDs are contractor- and jurisdiction-specific and can differ across locations.

Compare final LCD search matches across 1–15 states and Medicare Administrative Contractors. Different matching document counts or titles are policy signals, not proof of unequal beneficiary access or payment.

Retrieve one CMS National Coverage Analysis by document ID, including request, issue, benefit category, dates, decision memo, and public-comment status when supplied by CMS.

Search National Coverage Analyses (NCAs) and Coverage Analyses for Labs (CALs), including open and completed CMS evidence reviews. An open analysis is a policy process, not a coverage decision.

Retrieve one official Medicare National Coverage Determination by CMS document ID and optional version, including covered indications, limitations, effective dates, benefit category, and revision text.

ANSWERS "does Medicare cover X" / "is X covered by Medicare" / "what is Medicare's coverage policy for X" — searches current Medicare National Coverage Determinations (NCDs), the national policy documents that say whether Medicare covers a drug, device, procedure or therapy. Search by everyday product or therapy name ("CAR T-cell", "amyloid PET", "insulin pump"), by title, benefit category, or NCD number. NCDs describe national Medicare policy; they are not individualized coverage guarantees or medical advice.

Return a bounded sample of hospital-level Medicare fee-for-service outpatient rows for an exact APC and year, optionally filtered by state, with the authoritative matching-row count. APC payments are claims aggregates, not hospital revenue or margin.

Search CMS Medicare Part D spending by brand or generic name and return 2020–2024 spending, claims, beneficiaries, dosage units, and unit-cost trends. Gross Part D spending is not manufacturer revenue, net price, profit, prescriptions, or total US sales.

Profile Medicare Part D brand rows sharing an exact generic name, including CMS’s reported manufacturer count and 2020–2024 spending/use trends. Manufacturer count is a CMS aggregate, not a list of companies, products on market, or market share.

Return a bounded sample of Medicare Part D prescriber-by-drug rows for an exact brand name in one year, optionally filtered by state, with the authoritative matching-row count. This is not a prescriber ranking and suppressed/non-Part-D activity is absent.

Rank Medicare Part D drugs by total gross spending for a year — the biggest drugs in the Part D program, highest first. Answers "which drugs have the highest Medicare Part D spending", "top Part D drugs by cost", "what does Medicare spend the most on". Returns brand name, generic name and total spending. Spending is gross, before confidential manufacturer rebates.

Return a bounded API-order sample of Medicare post-acute provider rows for home health, hospice, or skilled nursing in one year and optional state, with the authoritative matching-row count. Payments are not provider revenue or margin.

Show annual national Medicare fee-for-service beneficiaries, stays, service days, and payments for home health, hospice, or skilled nursing. Program definitions and year basis differ by service and the figures are not provider revenue.

UTILIZATION ANALYTICS for a product whose HCPCS billing codes you ALREADY KNOW: requires 1-5 caller-supplied HCPCS codes and combines their annual Medicare fee-for-service claim volumes and payments with matching coverage-policy documents. Use when you have the codes and want spend, volume and trend. For a plain coverage question with no codes in hand, medicare_ncd_search answers it directly. CMS does not validate the product-to-code association; verify coding and policy details independently.

Return a bounded sample of provider-level Medicare fee-for-service rows for one HCPCS code, optionally filtered by state, with the authoritative matching-row count. This is not a provider ranking and excludes suppressed/non-FFS activity.

Recently published or updated national Medicare coverage documents from CMS, including NCDs, NCAs, CALs, MEDCAC meetings, and technology assessments.