# Medicare Pricing (npm · @pipeworx/mcp-medicare-pricing)

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

- Trust score: 82/100 (high trust)
- Change this week: +3
- Registry status: active
- Liveness: live
- Owner verified: no
- Last scored: 2026-11-05

## Components

- remote · `gateway.pipeworx.io`: 64/100, [markdown](https://verifymcp.io/servers/pipeworx-io-medicare-pricing/medicare-pricing-mcp.md), [page](https://verifymcp.io/servers/pipeworx-io-medicare-pricing/medicare-pricing-mcp)
- npm · `@pipeworx/mcp-medicare-pricing`: 82/100 (this document), [markdown](https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing.md), [page](https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing)

## Channel facts

- Registry: `npm`
- Package: `@pipeworx/mcp-medicare-pricing`
- Version: `0.2.1`
- Transport: `stdio`

## Trust breakdown

How this component scores in each security and reliability category. Every signal is checked automatically from public evidence about the published package, including repeated runs of it in an isolated sandbox, and we only credit what we can confirm. Scores are 0–100 per category. Scoring method: https://verifymcp.io/docs/scoring (what has changed: https://verifymcp.io/docs/scoring/changelog)

Scored 2026-11-05.

- **Supply Chain Security**: 100/100
  - No malware found by supply-chain analysis.
  - No known CVEs affecting this package version or its production dependencies.
  - No install/post-install scripts declared.
  - No production dependencies, so there is no dependency health to assess.
- **Provenance & Transparency**: 97/100
  - Source repository is publicly reachable at the declared URL.
  - Cryptographically verified build provenance (signed, bound to pipeworx-io/mcp-medicare-pricing).
  - Clear OSI-approved license (MIT).
  - Actively maintained (last published 2 days ago).
  - Disclosure check failed: no security disclosure policy was found in the source repository.
- **Schema Quality & AI Usability**: 62/100
  - AI-judged instruction clarity (excellent).
  - Context-footprint check failed: tool/resource definitions use about 3776 tokens (~314/item across 12 items; 12 tools + 0 resources), over budget; trim descriptions and params.
  - Usage-examples check failed: none of the tools include examples.
- **Stability & Change Management**: 23/100
  - Stability observed for 7 of 30 days with no destabilising changes; credit accrues until the full window elapses.
- **Tool Coverage**: 100/100
  - 100% of tools have a non-trivial description (not blank, and not just the tool's name).
  - 100% of tool parameters carry a description.
- **Tool Safety**: 100/100
  - No prompt-injection markers were found in the server instructions, tool names or descriptions we captured.
  - We read all 12 captured tool definition(s), and no name or description among them implies an irreversible operation.
  - An AI judge read all 13 captured unit(s) of tool text and found none that tries to manipulate the model reading it.
- **Capabilities**: 100/100
  - Implements a supported MCP spec version (2025-11-25); the latest is 2026-07-28.

## Install

### How do I install the Medicare Pricing MCP server?

Medicare Pricing runs locally as an npm package, launched with npx -y @pipeworx/mcp-medicare-pricing. Ready-made configuration for Claude, Cursor, VS Code, Codex and 5 more is on this page, copied from each client's own documentation.

### Claude

```bash
claude mcp add pipeworx-io-medicare-pricing -- npx -y @pipeworx/mcp-medicare-pricing
```

### Cursor

```json
{
  "mcpServers": {
    "pipeworx-io-medicare-pricing": {
      "command": "npx",
      "args": [
        "-y",
        "@pipeworx/mcp-medicare-pricing"
      ]
    }
  }
}
```

### VS Code

```json
{
  "servers": {
    "pipeworx-io-medicare-pricing": {
      "command": "npx",
      "args": [
        "-y",
        "@pipeworx/mcp-medicare-pricing"
      ]
    }
  }
}
```

### Codex

```bash
codex mcp add pipeworx-io-medicare-pricing -- npx -y @pipeworx/mcp-medicare-pricing
```

### opencode

```json
{
  "$schema": "https://opencode.ai/config.json",
  "mcp": {
    "pipeworx-io-medicare-pricing": {
      "type": "local",
      "command": [
        "npx",
        "-y",
        "@pipeworx/mcp-medicare-pricing"
      ],
      "enabled": true
    }
  }
}
```

### OpenClaw

```bash
openclaw mcp add pipeworx-io-medicare-pricing --command npx --arg -y --arg @pipeworx/mcp-medicare-pricing
```

### Hermes

```yaml
mcp_servers:
  pipeworx-io-medicare-pricing:
    command: "npx"
    args: ["-y", "@pipeworx/mcp-medicare-pricing"]
```

### Netclaw

```json
{
  "McpServers": {
    "pipeworx-io-medicare-pricing": {
      "Transport": "stdio",
      "Command": "npx",
      "Arguments": [
        "-y",
        "@pipeworx/mcp-medicare-pricing"
      ]
    }
  }
}
```

### Vellum

```bash
assistant mcp add pipeworx-io-medicare-pricing -t stdio -c npx -a -y @pipeworx/mcp-medicare-pricing
```

### Other

```json
{
  "mcpServers": {
    "pipeworx-io-medicare-pricing": {
      "command": "npx",
      "args": [
        "-y",
        "@pipeworx/mcp-medicare-pricing"
      ]
    }
  }
}
```

## Changelog

Every change recorded for this component, newest first. Days that predate change tracking, or that we cannot explain, say so: "we were watching and nothing happened" and "we were not watching" are different claims.

### 2026-11-05 (score 82, +1)

No change was recorded against any check on this day. Stability & Change Management went from 20 to 23. That category is still filling its 30-day observation window: 6 days of observed history at the previous scan, 7 at this one. The score rises as the window fills, whether or not the server changes.

### 2026-11-04 (score 81, +15)

- [security improvement] Malware scan: unverified → pass

### 2026-11-03 (score 66, −13)

- [security regression] Malware scan: pass → unverified
- [functional improvement] Stability: unverified → 0.17
- [functional] Package version: 0.2.0 → 0.2.1

### 2026-10-30 (score 79, 0)

- [functional regression] Security disclosure: unverified → fail

### 2026-10-29 (score 79)

First indexed and scored.

## MCP tools (12)

### `medicare_physician_payment` (~344 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 much does Medicare pay for 99213", "what is code 27130 worth in Los Angeles", "reimbursement rate for an office visit in Texas", and fee-schedule or contract-rate benchmarking. Gives both the facility and non-facility amount (a procedure pays less in a hospital, because the hospital bills the overhead separately), the global period, and the status code saying whether the code is separately payable at all. States the fee-schedule YEAR and the locality it resolved to on every response, because a rate quoted for the wrong year or locality is a wrong number. Sourced from the CMS Physician Fee Schedule relative value files.

Input parameters:

- `code` (string, required): HCPCS or CPT code, e.g. "99213" (office visit) or "27130" (hip replacement).
- `locality` (string): Where the service is provided — a state code ("CA"), state name, or Medicare locality name ("Bakersfield", "Manhattan"). Payment varies by locality; omit only if you want the national picture.
- `modifier` (string): Optional HCPCS modifier, e.g. "26" (professional component) or "TC" (technical component).
- `year` (number): Fee-schedule year, e.g. 2026. Omit to use the newest loaded year, which is stated in the response.

### `medicare_lab_rate` (~179 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 Medicare pay for a comprehensive metabolic panel", "CLFS rate for 80053", "what does a lipid panel reimburse". States the year and quarter of the schedule used, since lab rates are republished quarterly. Sourced from the CMS Clinical Laboratory Fee Schedule.

Input parameters:

- `code` (string, required): Lab HCPCS/CPT code, e.g. "80053" (comprehensive metabolic panel) or "85025" (complete blood count).
- `year` (number): Schedule year. Omit for the newest loaded, which is stated in the response.

### `medicare_lab_test_lookup` (~399 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 Clinical Laboratory Fee Schedule, and the MolDX local coverage determinations (LCDs) and billing-and-coding articles for its test category. Answers "what does Medicare pay for Signatera", "what is the PLA code for Guardant360", "which MolDX LCD covers this test". Also accepts a lab name (e.g. "Natera") or a code. Also covers non-ADLT branded MAAA tests (Oncotype DX, Prosigna, MammaPrint, EndoPredict, Breast Cancer Index, Cologuard, Prolaris, Decipher, Afirma, ConfirmMDx, 4Kscore) and any test whose lab registered its code in the NCBI Genetic Testing Registry. Resolves in order: the CMS list of Advanced Diagnostic Laboratory Tests (ADLTs), a brand-to-code table of MAAA tests with MolDX billing articles, then NCBI GTR live; a test found in none returns brand_not_found naming every source checked. Sourced from CMS (ADLT list, Clinical Laboratory Fee Schedule, Medicare Coverage Database) and NCBI GTR.

Input parameters:

- `include_retired` (boolean): Also list retired LCDs/articles for the test category (default false). Contractors re-issue MolDX policies under new numbers, so an older citation may be a retired document.
- `test` (string, required): The test's brand or commercial name ("Signatera", "Guardant360 CDx"), the lab ("Natera"), or its code ("0340U").

### `medicare_dmepos_rate` (~531 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 rural and non-rural amounts, since Medicare pays DMEPOS by state rather than by the physician-fee-schedule locality. Answers "how much does Medicare pay for a CPAP machine (E0601)", "DMEPOS rate for a wheelchair in Texas", "what is the rural rate for this HCPCS code in Montana". Unlike medicare_physician_payment, this DOES include the HCPCS code description — DMEPOS uses HCPCS Level II, which CMS itself maintains and is not AMA copyright (CPT/HCPCS Level I is). States the fee-schedule YEAR and RELEASE (quarterly-ish: A=January, B=April, C=July, D=October) used on every response, and the modifier resolved (many DMEPOS codes price differently for rental "RR" vs. new purchase "NU" vs. used "UE" — pass one if you know it, otherwise the first modifier on file for the code is used and stated).

Input parameters:

- `code` (string, required): HCPCS Level II code, e.g. "E0601" (CPAP device) or "E1390" (oxygen concentrator).
- `modifier` (string): Optional HCPCS modifier, e.g. "RR" (rental), "NU" (purchase, new), "UE" (purchase, used). Many DMEPOS codes are priced only under one modifier; omit to use whichever is on file (stated in the respons…
- `release` (string): Quarterly release letter within the year: "A" (Jan), "B" (Apr), "C" (Jul), or "D" (Oct). Omit to use the newest loaded release for the resolved year.
- `state` (string): US state, DC, or territory (PR/VI) where the equipment is furnished — a 2-letter code ("TX") or full name ("Texas"). DMEPOS is priced by STATE, not by Medicare locality. Omit only for the raw record…
- `year` (number): Fee-schedule year, e.g. 2026. Omit to use the newest loaded year, which is stated in the response.

### `medicare_opps_rate` (~451 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 Payment System (OPPS) — the schedule that applies when the same service is billed by a hospital's outpatient department rather than a physician office (medicare_physician_payment) or a lab (medicare_lab_rate). Answers "what does Medicare pay for CPT 33289 in a hospital outpatient setting", "what is the APC for C2624", "is this device on pass-through status", "what is the OPPS payment rate and copay for this code". Flags device_pass_through and drug_or_biological_pass_through — whether the code is CURRENTLY in a CMS pass-through category (status indicator H or G), meaning it is paid separately, outside the normal APC amount, rather than packaged into the procedure it goes with. A packaged code (status indicator N, among others) still has a valid status_indicator but no apc/payment_rate_usd, because OPPS pays for it only as part of whatever procedure it is billed with — that is a normal result, not a missing one. States the fee-schedule YEAR and QUARTER (Q1=Jan, Q2=Apr, Q3=Jul, Q4=Oct) used on every response. Sourced from CMS, OPPS Addendum B.

Input parameters:

- `code` (string, required): HCPCS or CPT code, e.g. "33289" (CardioMEMS implant procedure) or "C2624" (implantable wireless pulmonary artery pressure sensor).
- `quarter` (string): Which quarterly release: "Q1".."Q4", or the release month CMS actually uses ("january"/"april"/"july"/"october"). Omit to use the newest loaded quarter for the resolved year.
- `year` (number): Calendar year, e.g. 2026. Omit to use the newest loaded year, which is stated in the response.

### `medicare_code_units_limit` (~200 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. Answers "what is the MUE for 99213", "how many units of this code can I bill", "why was my claim denied for units". Available for practitioner, outpatient hospital and DME settings, which have different limits for the same code. States the quarterly edit vintage in force. Sourced from the CMS National Correct Coding Initiative.

Input parameters:

- `code` (string, required): HCPCS/CPT code, e.g. "99213".
- `setting` (string): Which MUE table: "practitioner" (default), "outpatient_hospital", or "dme". The same code can carry different limits in each.

### `check_code_pair` (~257 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 modifier and documentation, or carries no edit in the loaded data. Answers "can I bill 99214 and 93000 together", "is there an NCCI edit between these two codes", "do I need a modifier for this code combination". Built from CMS's FULL NCCI PTP edit baseline (2026q3, v322r0), not just a rolling change window — a pair not found here has never had a CMS-recorded PTP edit as of the loaded vintage. The response always states the loaded vintage and setting resolved.

Input parameters:

- `code_a` (string, required): First HCPCS/CPT code, e.g. "99214".
- `code_b` (string, required): Second HCPCS/CPT code, e.g. "93000".
- `setting` (string): Which edit table: "practitioner" (default) or "hospital" (outpatient facility). Edits can differ between them.

### `explain_ncci_edit` (~234 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 99214", "what is bundled into this procedure", "why would this code be denied when billed with something else". Same full-baseline coverage as check_code_pair (CMS's FULL NCCI PTP edit baseline, 2026q3 v322r0, not just a rolling change window) — an empty result means no PTP edit has ever been recorded for this code, not merely "no recent change".

Input parameters:

- `code` (string, required): HCPCS/CPT code, e.g. "99214".
- `setting` (string): Which edit table: "practitioner" (default) or "hospital".
- `status` (string): Filter to "active" (default — currently in effect) or "all" (include deleted edits too).

### `medicare_fqhc_pps_rate` (~278 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 is the FQHC PPS base rate", "how much does Medicare pay an FQHC per encounter", "FQHC PPS rate for 2025 vs 2026". Medicare pays an FQHC the LESSER of its actual charges or this PPS rate for all FQHC services furnished to a beneficiary on a day with a qualifying face-to-face visit — it is a per-DAY encounter rate, not a fee per procedure code (unlike medicare_physician_payment/medicare_lab_rate). This tool returns only the national base rate before the geographic adjustment; for the GAF-adjusted amount in a named locality use medicare_fqhc_gaf. Omit year for the newest loaded year plus the full known history (small — CMS publishes one number a year); pass year for one row.

Input parameters:

- `year` (number): Calendar year, e.g. 2026. Omit to get the newest loaded year AND the full history table.

### `medicare_gpci_lookup` (~351 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", "Medicare geographic practice cost index for San Francisco", "work GPCI Manhattan 2025", "which Medicare localities does California have". Medicare pays by LOCALITY, not state (California has nine), so a state or ambiguous name returns every matching locality rather than one chosen quietly, and the resolution is stated. The work GPCI is the floored value CMS pays on (1.0 floor where it applies). Pass state ("FL" or "Florida"), a locality name ("Bakersfield"), and/or locality_number ("99"); year defaults to the newest loaded and is stated. For the FQHC-specific adjustment see medicare_fqhc_gaf; for a dollar payment see medicare_physician_payment. Sourced from the CMS Physician Fee Schedule geographic practice cost indices.

Input parameters:

- `locality` (string): State code ("FL"), state name ("Florida"), or Medicare locality name ("Bakersfield", "Manhattan", "Rest of Florida").
- `locality_number` (string): Optional Medicare locality number, e.g. "99" (Rest of Florida) — needs state or locality to say which state.
- `state` (string): Optional state code or name; combine with locality_number to pin one locality.
- `year` (number): Calendar year, e.g. 2025. Omit for the newest loaded year (stated in the response).

### `medicare_fqhc_gaf` (~383 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 "FQHC PPS GAF for Orlando, Florida 2025", "CY2026 FQHC geographic adjustment Rest of California", "what is the FQHC PPS rate in Alaska". The GAF is CMS's own published number per locality (adapted from the work and practice-expense GPCIs, with the 1.0 floor), not something this tool estimates. A state returns all its localities; a city is not a locality, so name the locality or pick from the list (Florida has Fort Lauderdale, Miami and Rest of Florida). Complements medicare_fqhc_pps_rate (national base rate) and medicare_gpci_lookup (the underlying GPCIs). Years 2018-2026 loaded; the GAF-adjusted rate is returned for 2022-2026 (years whose national base rate this pack carries) and is null with a stated reason for 2018-2021. Sourced from the CMS FQHC PPS geographic adjustment factor tables.

Input parameters:

- `locality` (string): State code ("FL"), state name ("Florida"), or Medicare locality name ("Fort Lauderdale", "Rest of Florida"). A bare state returns all of its localities.
- `locality_number` (string): Optional Medicare locality number, e.g. "99"; with a state it pins one locality.
- `year` (number): Calendar year, 2018-2026. Omit for the newest loaded year (stated in the response).

### `medicare_pricing_coverage` (~112 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 on check_code_pair / explain_ncci_edit — they see only pairs that changed within the loaded quarterly window, not the full AMA-licence-gated PTP baseline.

## Diagnostics

Captured diagnostic sections: Provenance, Dependencies. The full working is on the page: https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing#diagnostics

## Score history

- 2026-11-05: 82
- 2026-11-04: 81
- 2026-11-03: 66
- 2026-11-02: 79
- 2026-11-01: 79
- 2026-10-31: 79
- 2026-10-30: 79
- 2026-10-29: 79

## Common questions

### What is the Medicare Pricing MCP server?

Medicare Pricing is an MCP server listed in the public MCP registry as io.github.pipeworx-io/medicare-pricing. What does Medicare PAY, physician fee schedule, lab rates, and per-day unit limits. This page covers its npm package (@pipeworx/mcp-medicare-pricing).

### Is the Medicare Pricing MCP server safe to use?

Medicare Pricing scores 82 out of 100 on VerifyMCP. We found no known CVEs affecting it as of 5 November 2026. It declares no install or post-install scripts. Its build provenance is signed and verified. That is a record of what we were able to check automatically, not an endorsement. The category breakdown on this page shows every signal behind the number, including the ones we could not confirm.

### What tools does the Medicare Pricing MCP server expose?

Medicare Pricing exposes 12 tools: medicare_physician_payment, medicare_lab_rate, medicare_lab_test_lookup, medicare_dmepos_rate, medicare_opps_rate, and 7 more. Their descriptions and schemas cost roughly 3,719 tokens of context every time the server is loaded.

### Is the Medicare Pricing MCP server still maintained?

Medicare Pricing is still listed as active in the MCP registry. We last reached this channel on 5 November 2026. Those dates come from our own scans of the registry and the channel itself, not from anything the publisher announced.

### What licence is the Medicare Pricing MCP server under?

Medicare Pricing declares the MIT licence, which is OSI-approved. That covers the source only, and says nothing about the cost of any service it calls.

### What did VerifyMCP test on the Medicare Pricing MCP server?

VerifyMCP ran 16 checks on Medicare Pricing, covering Malware scan, Known CVEs, Install scripts, Dependency health and 12 more. Endpoint Security and Transport & Reachability do not apply to an npm package, so they were not tested. The score does not measure everything, and the scoring documentation lists what it leaves out.

## Links

- npm package: https://www.npmjs.com/package/@pipeworx/mcp-medicare-pricing
- Socket report: https://socket.dev/npm/package/@pipeworx/mcp-medicare-pricing
- Repository: https://github.com/pipeworx-io/mcp-medicare-pricing
- Website: https://pipeworx.io/packs/medicare-pricing
- Changelog RSS feed: https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing.xml
- Changelog JSON feed: https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing/changelog.json
- Trust report (JSON): https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing.json
- HTML version of this page: https://verifymcp.io/servers/pipeworx-io-medicare-pricing/pipeworx-mcp-medicare-pricing