@pipeworx/mcp-medicare-pricing 0.1.0

package/.pipeworx-staged-ok

@@ -0,0 +1,6 @@
+{
+  "staged_at": "2026-09-23T20:33:13.962Z",
+  "publisher_blob": "da6994091dc9dcc6a7433084251ca4bbd58b4bed",
+  "publisher_commit": "1c417b2cfcdac06e2d9210e869265722ef013f20",
+  "note": "Written by scripts/publish-pack.sh as its LAST step. Its presence is the ONLY thing that lets stage-unpublished-packs.sh skip this pack. Deleting this dir is the correct way to force a rebuild."
+}

package/LICENSE

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+MIT License
+
+Copyright (c) 2026 Mojibake Inc.
+
+Permission is hereby granted, free of charge, to any person obtaining a copy
+of this software and associated documentation files (the "Software"), to deal
+in the Software without restriction, including without limitation the rights
+to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
+copies of the Software, and to permit persons to whom the Software is
+furnished to do so, subject to the following conditions:
+
+The above copyright notice and this permission notice shall be included in all
+copies or substantial portions of the Software.
+
+THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
+IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
+FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
+AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
+LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
+OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE
+SOFTWARE.

package/README.md

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+# medicare-pricing
+
+What Medicare **pays** — physician fee schedule, lab rates, and per-day unit
+limits. The companion to `medicare-coverage`, which answers whether something is
+covered but not what it is worth.
+
+Part of [Pipeworx](https://pipeworx.io) — an MCP gateway connecting AI agents to 1663+ live data sources.
+
+## Tools
+
+| Tool | Answers |
+|---|---|
+| `medicare_physician_payment` | "How much does Medicare pay for 99213 in Los Angeles?" — RVUs and dollars, locality-adjusted. |
+| `medicare_lab_rate` | "What does a comprehensive metabolic panel reimburse?" — national CLFS rate. |
+| `medicare_dmepos_rate` | "How much does Medicare pay for a CPAP machine (E0601) in Texas?" — state-priced, rural vs non-rural. |
+| `medicare_code_units_limit` | "How many units of this code will they pay for in one day?" — NCCI MUE. |
+| `check_code_pair` | "Can I bill 00142 and 64474 together?" — NCCI PTP edit + modifier indicator for a code pair. |
+| `explain_ncci_edit` | "What is bundled into (or bundles into) this code?" — every recorded PTP edit for one code. |
+| `medicare_pricing_coverage` | Which vintages are loaded, including the PTP baseline vintage. |
+
+## Auth
+
+None. No key, no account.
+
+## Data sources
+
+All from CMS, all downloadable files with no API:
+
+- **Physician Fee Schedule relative value files** (RVUs + GPCIs) — annual
+- **Clinical Laboratory Fee Schedule** — quarterly
+- **DMEPOS fee schedule** (durable medical equipment, prosthetics, orthotics, supplies) — quarterly (as necessary): A=Jan, B=Apr, C=Jul, D=Oct
+- **NCCI Medically Unlikely Edits** — quarterly
+- **NCCI PTP quarterly additions/deletions/revisions files** — quarterly (see below — a narrower source than the other three)
+
+## Vintage is not a detail
+
+Fee schedules change annually and NCCI/CLFS quarterly. Quoting a 2026 procedure
+at 2024 rates is a wrong number with billing consequences, so **every response
+states the year** (and quarter where quarterly) it used, and sets
+`year_was_defaulted` when the caller did not name one. Asking for a year that is
+not loaded returns `year_not_loaded` rather than silently answering with a
+different year's rates.
+
+## Locality is not state
+
+Medicare pays by geographic **locality**. California alone has nine. The same
+office visit (99213, 2026) pays:
+
+| Locality | Non-facility |
+|---|---|
+| Bakersfield, CA | $99.52 |
+| Alabama | $87.79 |
+
+A 13% swing a state-shaped answer would hide. `medicare_physician_payment`
+resolves the locality explicitly, states what it resolved to, and lists other
+localities that matched so a caller can pick a different one.
+
+Payment is computed with the real formula and the arithmetic is returned so it
+can be audited:
+
+```
+((work RVU × PW GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)) × conversion factor
+```
+
+Facility and non-facility are both given — a procedure pays less in a hospital
+because the facility bills its own fee separately.
+
+## Whether two codes can be billed together — the full PTP baseline
+
+**`check_code_pair` and `explain_ncci_edit` now cover the FULL NCCI
+procedure-to-procedure (PTP) edit baseline, not a rolling change window
+(fleet #1293, 2026-09-07).** CMS distributes the complete PTP edit table
+behind an AMA CPT licence click-through (`/license/ama?file=...` on
+cms.gov). Bruce authorized accepting that licence on the company's behalf via
+the Needs Bruce dashboard (2026-09-07); the licence text was read in full
+before any data shipped — see "NCCI PTP licence" below for the quoted terms
+and the reasoning for why this pack's serving shape stays inside them.
+
+**Loaded:** the 2026 Quarter 3 baseline (v322r0, effective 2026-07-01 — the
+newest vintage actually in effect; CMS had already posted Q4 2026 at ingest
+time, but that isn't effective until 2026-10-01 and using it would have
+answered today's queries with tomorrow's rules). The 8 baseline files
+(practitioner + hospital × 4 code-range splits each) hold 4,498,118 raw
+historical-episode rows — the same `(column1, column2)` pair can have several
+add/delete/re-add episodes over the years — collapsed to **4,109,749 distinct
+pairs** by keeping each pair's open-ended (currently active) episode, or else
+its most recently closed one. The prior **2025q1..2026q3 quarterly change
+files are re-applied ON TOP of the baseline**, in that order, so a pair the
+quarterly files recorded as deleted cannot be resurrected by an older baseline
+row.
+
+**A NOT-FOUND answer now means CMS has never recorded a PTP edit for that
+pair** — not merely "no recorded change in this window", which was the
+scope limit before this fleet task. `medicare_code_units_limit` remains the
+separate **units** edit (one code, not a pair) and was never affected by this
+limit.
+
+### NCCI PTP licence
+
+The CMS licence click-through (same boilerplate CMS uses across its whole AMA
+CPT-derived file family — the physician fee schedule, MUE, and PTP downloads
+all carry it) reads, in relevant part:
+
+> CPT codes, descriptions and other data only are copyright 1995-2025 American
+> Medical Association. All rights reserved... You, your employees and agents
+> are authorized to use CPT only as contained in the following authorized
+> materials of Centers for Medicare and Medicaid Services (CMS) internally
+> within your organization within the United States for the sole use by
+> yourself, employees and agents. Use is limited to use in Medicare, Medicaid
+> or other programs administered by CMS... Any use not authorized herein is
+> prohibited, including... making copies of CPT for resale and/or license,
+> transferring copies of CPT to any party not bound by this agreement,
+> creating any modified or derivative work of CPT, or making any commercial
+> use of CPT.
+
+Read maximally literally, "internal use" and "CMS-administered programs only"
+would forbid nearly all third-party commercial reuse of ANY Medicare
+fee-schedule data — an interpretation the entire health-IT industry operates
+against daily (claims clearinghouses, EHR vendors, and billing software all
+reference CPT codes commercially). This pack's existing, already-shipped
+design applies the standard industry reading of the opening sentence — "CPT
+codes, **descriptions** and other data" are the copyrighted, licensed
+material; the CMS-computed derivative numbers indexed by those codes (RVUs,
+payment amounts, edit modifier indicators) are federal work product and are
+returned, while the AMA's own descriptive text is never stored or served. The
+PTP baseline's own "PTP Edit Rationale" column (a ~12-value CMS-authored
+categorical reason set, e.g. "Standards of medical/surgical practice") is not
+stored either, purely to keep this load a strict superset of the existing
+table shape (no schema change) — not because it reads as AMA content. This is
+the same theory already governing this pack's RVU/CLFS/MUE data; the PTP
+click-through does not introduce a new prohibition beyond what the rest of the
+pack already operates under, but the literal breadth of "internal use" /
+"CMS-administered programs" language is flagged here for anyone reviewing
+licence exposure across the pack.
+
+## No procedure descriptions — except DMEPOS
+
+Every PFS/CLFS source file opens with *"CPT codes, descriptions and other data
+only are copyright <year> American Medical Association"*. The RVU file scopes
+it precisely — *codes and descriptions only* — so the CMS-computed numbers are
+federal data and are returned, while the AMA's descriptive text is neither
+stored nor served. Callers pass a code they already hold.
+
+**DMEPOS is the exception, on purpose.** It uses HCPCS **Level II** codes
+(E/K/L/A-codes), which CMS itself maintains — unlike CPT (HCPCS Level I),
+which is AMA copyright. The DMEPOS source file's own DMEREAD/DMEBACK
+documentation carries no AMA/copyright notice anywhere (checked), so
+`medicare_dmepos_rate` DOES return the code description.
+
+## DMEPOS pays by state, not locality
+
+Medicare pays DMEPOS by **state** (not by the physician-fee-schedule
+locality), with a separate **rural** and **non-rural** amount per state. CMS's
+own source file is one row per (HCPCS, modifier) with 53 state/territory
+columns × 2 (non-rural/rural) = 106 rate columns; this pack keeps that row
+grain and folds the 106 columns into one JSONB map rather than exploding to
+~374,000 rows per release. `medicare_dmepos_rate` always returns both figures,
+labelled, and says explicitly when a state carries no separately-adjusted
+rural amount (a real "no adjustment" fact from the source file, not a missing
+value) rather than presenting a bare `null`.
+
+## Refreshing
+
+```bash
+node scripts/ingest-medicare-pricing.mjs                    # current vintages: RVU, GPCI, CLFS, MUE
+node scripts/ingest-medicare-pricing.mjs --year 2025 --rvu rvu25d --clfs 25clabq4
+
+node scripts/ingest-ncci-ptp.mjs                             # PTP quarterly change overlay (default: 2025q1..2026q3)
+node scripts/ingest-ncci-ptp.mjs --quarters 2026q4            # add just the newest quarter on a refresh
+
+node scripts/ingest-ncci-ptp-baseline.mjs --dir /path/to/8-zips  # full PTP baseline re-load (rare — new CMS vintage only)
+                                                                  # ALWAYS re-run ingest-ncci-ptp.mjs immediately after —
+                                                                  # the quarterly overlay must land on top of the baseline,
+                                                                  # not the other way around (see script header comment).
+                                                                  # Requires manually downloading the 8 baseline zips
+                                                                  # through the CMS AMA-licence click-through first — no
+                                                                  # automated fetch can complete that flow (503s to curl
+                                                                  # and to a bare browser GET of the file URL; only a real
+                                                                  # interactive click on the license page's Accept button
+                                                                  # works).
+
+node scripts/ingest-dmepos.mjs                                # newest DMEPOS release (default: 2026 release C)
+node scripts/ingest-dmepos.mjs --year 2026 --release D         # add a new release when CMS posts one
+```
+
+Loaded as of writing: 19,226 RVU rows, 109 localities, 2,081 lab rates, 3,531
+DMEPOS code/modifier rows (2026 release C, 53 states/territories each), 33,354
+MUEs, **4,109,749 distinct NCCI PTP pairs** — the FULL CMS baseline (2026q3,
+v322r0) with the 2025q1..2026q3 quarterly change files layered on top (fleet
+#1293, 2026-09-07; superseded the prior 182,286-pair change-window-only
+coverage). All loaders refuse rather than reporting an empty parse as success.
+
+`ingest-dmepos.mjs` resolves the current download from the DMEPOS release
+subpage rather than guessing the zip filename — CMS's DMEPOS naming is not
+stable (a release page 404s before it is posted, and old release URLs have
+301-redirected to renamed paths), so it reads
+`.../dmepos-fee-schedule/dme<yy>[-<letter>]` for the current `.zip` href on
+every run, the same pattern `ingest-medicare-pricing.mjs` already uses for the
+PFS RVU page.
+
+`ingest-ncci-ptp.mjs` is additive/idempotent by design — re-running the full
+default window is safe (upserts on `service_type,column1,column2`), and adding
+a new quarter to `--quarters` widens the window forward without needing to
+re-fetch history.
+
+## Quick Start
+
+Add to your MCP client (Claude Desktop, Cursor, Windsurf, etc.):
+
+```json
+{
+  "mcpServers": {
+    "medicare-pricing": {
+      "url": "https://gateway.pipeworx.io/medicare-pricing/mcp"
+    }
+  }
+}
+```
+
+### What this endpoint actually serves
+
+`tools/list` at `https://gateway.pipeworx.io/medicare-pricing/mcp` returns the tools in the table
+above **plus the shared Pipeworx meta-tools** — `ask_pipeworx`,
+`discover_tools`, `search_within`, `remember`/`recall` and the rest of the
+gateway-wide set. So the tool count you see is larger than this table: a
+single-pack endpoint currently lists roughly 30 shared tools alongside the
+pack's own. The connection's `initialize` response states its exact scope, and
+is the authoritative answer for a given day.
+
+This is deliberate, not multiplexing by accident. The meta-tools are what let a
+scoped connection answer a question this pack does not cover — via
+`ask_pipeworx`, which routes across the whole catalog — without you adding a
+second MCP server. There is currently no way to mount a pack endpoint without
+them; if the extra schemas cost you more context than the routing is worth,
+connect to the full gateway once rather than to several pack endpoints.
+
+Or connect to the full Pipeworx gateway to get every pack's tools listed
+directly, instead of just this one's:
+
+```json
+{
+  "mcpServers": {
+    "pipeworx": {
+      "url": "https://gateway.pipeworx.io/mcp"
+    }
+  }
+}
+```
+
+Both URLs reach the same gateway and the same 1663+ data sources. The
+only difference is which pack's tools are listed **directly**; `ask_pipeworx`
+reaches all of them from either one.
+
+## No MCP client? Call it over HTTP
+
+```bash
+curl -X POST https://gateway.pipeworx.io/v1/tools/medicare_physician_payment \
+  -H 'Content-Type: application/json' \
+  -d '{"code":"99213","locality":"CA"}'
+```
+
+No account needed for the first calls. Inspect any tool: `GET https://gateway.pipeworx.io/v1/tools/medicare_physician_payment`. Find one: `POST https://gateway.pipeworx.io/v1/tools/search_packs` with `{"query":"..."}`.
+
+## Standalone (no gateway account)
+
+This package also runs as a local stdio MCP server — no Pipeworx account, no
+gateway round-trip:
+
+```json
+{
+  "mcpServers": {
+    "medicare-pricing": {
+      "command": "npx",
+      "args": ["-y", "@pipeworx/mcp-medicare-pricing"]
+    }
+  }
+}
+```
+
+Or run it directly to confirm it starts:
+
+```bash
+npx -y @pipeworx/mcp-medicare-pricing
+```
+
+It speaks MCP over stdin/stdout and answers `initialize`/`tools/list`/`tools/call`
+for **only** this pack's tools — none of the shared meta-tools the gateway
+connection above adds. Same source, same tools, no ask_pipeworx routing.
+
+## Using with ask_pipeworx
+
+Instead of calling tools directly, you can ask questions in plain English —
+this works on the pack endpoint above as well as on the full gateway:
+
+```
+ask_pipeworx({ question: "your question about Medicare Pricing data" })
+```
+
+The gateway picks the right tool and fills the arguments automatically.
+
+## More
+
+- [Docs and guides](https://pipeworx.io/docs)
+- [pipeworx.io](https://pipeworx.io)
+
+## License
+
+MIT

package/bin/cli.js

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+#!/usr/bin/env node
+//
+// Entry point for `npx @pipeworx/mcp-<slug>`.
+//
+// Packs ship as raw TypeScript (no build step — see publish-pack.sh for why:
+// tsx sidesteps every extensionless-import / bare-JSON-import edge case a
+// per-pack tsc build would have to solve one pack at a time). This file
+// registers tsx's ESM loader programmatically, then hands off to src/server.ts,
+// which wraps the pack's {tools, callTool} export in a stdio MCP server.
+//
+// Copied verbatim into every published pack repo by scripts/publish-pack.sh —
+// edit this file, not a per-pack copy.
+import { register } from 'tsx/esm/api';
+
+register();
+
+await import('../src/server.ts');

package/package.json

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+{
+  "name": "@pipeworx/mcp-medicare-pricing",
+  "version": "0.1.0",
+  "description": "What does Medicare PAY — physician fee schedule, lab rates, and per-day unit",
+  "type": "module",
+  "main": "src/index.ts",
+  "types": "src/index.ts",
+  "bin": {
+    "mcp-medicare-pricing": "bin/cli.js"
+  },
+  "keywords": ["mcp", "mcp-server", "model-context-protocol", "pipeworx", "medicare-pricing"],
+  "license": "MIT",
+  "repository": {
+    "type": "git",
+    "url": "git+https://github.com/pipeworx-io/mcp-medicare-pricing.git"
+  },
+  "scripts": {
+    "typecheck": "tsc --noEmit"
+  },
+  "dependencies": {
+    "@modelcontextprotocol/sdk": "^1.30.0",
+    "tsx": "^4.19.0"
+  },
+  "devDependencies": {
+    "typescript": "^5.9.3",
+    "@cloudflare/workers-types": "^4.20260405.1"
+  }
+}

package/server.json

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+{
+  "$schema": "https://static.modelcontextprotocol.io/schemas/2025-12-11/server.schema.json",
+  "name": "io.github.pipeworx-io/medicare-pricing",
+  "title": "Medicare Pricing",
+  "description": "What does Medicare PAY — physician fee schedule, lab rates, and per-day unit",
+  "version": "0.1.0",
+  "websiteUrl": "https://pipeworx.io/packs/medicare-pricing",
+  "repository": {
+    "url": "https://github.com/pipeworx-io/mcp-medicare-pricing",
+    "source": "github"
+  },
+  "remotes": [
+    {
+      "type": "streamable-http",
+      "url": "https://gateway.pipeworx.io/medicare-pricing/mcp"
+    }
+  ]
+}