@pipeworx/mcp-medicare-pricing 0.1.2 → 0.1.3

package/README.md

@@ -57,8 +57,26 @@ were checked and rejected:
 - **NCBI GTR** — knows Signatera and Guardant360 but its `cptcode` field is
   empty for them.
 
-So coverage is limited to ADLTs. A test outside the list gets
-`found: false, reason: not_on_adlt_list` and a pointer to `medicare_lab_rate`.
+That made coverage ADLT-only, and fleet #2458 measured the cost: Oncotype DX
+(81519, a Category I MAAA code, not an ADLT) routed here 5/5 and came back
+`found: false`. Resolution now runs through three sources in order:
+
+1. **CMS ADLT list** (`src/adlt.ts`, below).
+2. **MAAA brand table** (`src/brand-codes.ts`) -- non-ADLT branded tests whose
+   proprietary name is tied to a code in CPT Appendix O and which each have a
+   brand-named or category MolDX billing article on the CMS MCD (Oncotype DX
+   breast/DCIS/colon/prostate, Prosigna, MammaPrint, EndoPredict, Breast
+   Cancer Index, Cologuard, Prolaris, Decipher, Afirma, ConfirmMDx, 4Kscore).
+   Only brand -> code -> lab FACTS are kept, never AMA descriptor text. Every
+   code was checked to carry a CLFS rate on 2026-09-26. To add a row: confirm
+   the pair in a public source, confirm `medicare_lab_rate` has a rate, and set
+   `coverage_topic` to a phrase from a live MolDX article title.
+3. **NCBI GTR, live** -- where the performing lab registered a CPT code
+   (e.g. Afirma -> 81546, Decipher -> 81542). Labelled lab-reported. Sparse:
+   Oncotype DX and Signatera carry no code there, which is why it is last.
+
+A test found in none returns `found: false, reason: brand_not_found` with
+`sources_checked` naming all three, and a pointer to `medicare_lab_rate`.
 
 **Copy, not proxy.** The list is a two-page PDF with no API, and the gateway
 has no PDF parser, so the rows are baked into `src/adlt.ts`. The PDF's "Test

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "@pipeworx/mcp-medicare-pricing",
-  "version": "0.1.2",
+  "version": "0.1.3",
   "description": "What does Medicare PAY — physician fee schedule, lab rates, and per-day unit",
   "type": "module",
   "main": "src/index.ts",
@@ -26,7 +26,7 @@
     "@cloudflare/workers-types": "^4.20260405.1"
   },
   "pipeworx": {
-    "sourceHash": "v1-39abb67f2c97d76656d44948e3ff83744176d3ab644ad6bb0dfb4fe227df10b6",
-    "sourceCommit": "6182c4cfebddb94950e060b5d2fca18f18ad1aca"
+    "sourceHash": "v1-4bc045e1de966c1a9bd8a24cb7841ad9803cdfe842f2b6db807b64562639bc33",
+    "sourceCommit": "6fe8fb3e01138dfc4ebe7d5c246503aab9278d06"
   }
 }

package/server.json

@@ -3,7 +3,7 @@
   "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": "0.1.2",
+  "version": "0.1.3",
   "websiteUrl": "https://pipeworx.io/packs/medicare-pricing",
   "repository": {
     "url": "https://github.com/pipeworx-io/mcp-medicare-pricing",

package/src/brand-codes.ts

@@ -0,0 +1,113 @@
+/**
+ * Branded lab tests that are NOT ADLTs but carry their own code (fleet #2458).
+ *
+ * #2426 resolved brand names only through the CMS ADLT list, so the most-asked
+ * branded test of all -- Oncotype DX, a Category I MAAA code (81519) -- came
+ * back found:false. Two more sources close the class:
+ *
+ *  1. THIS TABLE: the Category I MAAA tests whose proprietary name is tied to
+ *     its code in CPT Appendix O, each also the subject of a brand-named MolDX
+ *     billing-and-coding article on the CMS Medicare Coverage Database. What is
+ *     kept is the FACT (brand -> code -> lab), never the AMA descriptor text,
+ *     under the same rule as adlt.ts. Every code here was checked on
+ *     2026-09-26 to carry a rate on the loaded CLFS.
+ *  2. NCBI GTR (Genetic Testing Registry), fetched LIVE per request: labs
+ *     register their tests there and many state the CPT code. US government
+ *     work, keyless E-utilities. It is lab-reported, so the answer says so.
+ *
+ * `coverage_topic` is a phrase from the title of the test's MolDX policy (a
+ * brand-named billing article where one exists), matched live against the CMS
+ * Coverage API title list -- ours, not CMS's, checked 2026-09-26.
+ */
+
+export interface BrandTest {
+  code: string;
+  lab: string;
+  test_name: string;
+  aliases: string[];
+  coverage_topic: string | null;
+}
+
+export const BRAND_SOURCE = 'CPT Appendix O (MAAA) proprietary-name-to-code pairs, each with a brand-named or category MolDX billing article on the CMS Medicare Coverage Database';
+export const BRAND_DATA_AS_OF = '2026-09-26';
+
+export const BRAND_TESTS: BrandTest[] = [
+  { code: '81519', lab: 'Genomic Health (Exact Sciences)', test_name: 'Oncotype DX Breast Recurrence Score', aliases: ['Oncotype DX', 'Oncotype DX Breast', 'Oncotype DX Breast Cancer Assay', 'Oncotype'], coverage_topic: 'Oncotype DX Breast Cancer Assay' },
+  { code: '0045U', lab: 'Genomic Health (Exact Sciences)', test_name: 'Oncotype DX Breast DCIS Score', aliases: ['Oncotype DX DCIS', 'Oncotype DCIS'], coverage_topic: 'Oncotype DX Breast Cancer for DCIS' },
+  { code: '81525', lab: 'Genomic Health (Exact Sciences)', test_name: 'Oncotype DX Colon Recurrence Score', aliases: ['Oncotype DX Colon', 'Oncotype DX Colon Cancer Assay'], coverage_topic: 'Oncotype DX Colon Cancer' },
+  { code: '0047U', lab: 'Genomic Health (Exact Sciences)', test_name: 'Oncotype DX Genomic Prostate Score', aliases: ['Oncotype DX Prostate', 'Genomic Prostate Score', 'Oncotype GPS'], coverage_topic: 'Prostate Cancer Genomic Classifier Assay' },
+  { code: '81518', lab: 'Biotheranostics (Hologic)', test_name: 'Breast Cancer Index', aliases: ['BCI'], coverage_topic: 'Breast Cancer Index' },
+  { code: '81520', lab: 'NanoString Technologies (Veracyte)', test_name: 'Prosigna', aliases: ['Prosigna Breast Cancer Prognostic Gene Signature Assay', 'PAM50'], coverage_topic: 'Prosigna' },
+  { code: '81521', lab: 'Agendia', test_name: 'MammaPrint', aliases: [], coverage_topic: 'MammaPrint' },
+  { code: '81522', lab: 'Myriad Genetics', test_name: 'EndoPredict', aliases: [], coverage_topic: 'EndoPredict' },
+  { code: '81528', lab: 'Exact Sciences', test_name: 'Cologuard', aliases: [], coverage_topic: null },
+  { code: '81541', lab: 'Myriad Genetics', test_name: 'Prolaris', aliases: [], coverage_topic: 'Prostate Cancer Genomic Classifier Assay' },
+  { code: '81542', lab: 'Veracyte (Decipher Biosciences)', test_name: 'Decipher Prostate', aliases: ['Decipher', 'Decipher Prostate Genomic Classifier'], coverage_topic: 'Prostate Cancer Genomic Classifier Assay' },
+  { code: '81546', lab: 'Veracyte', test_name: 'Afirma Genomic Sequencing Classifier', aliases: ['Afirma', 'Afirma GSC'], coverage_topic: 'Molecular Testing for Risk Stratification of Thyroid Nodules' },
+  { code: '81551', lab: 'MDxHealth', test_name: 'ConfirmMDx', aliases: ['ConfirmMDx for Prostate Cancer'], coverage_topic: 'Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer' },
+  { code: '81539', lab: 'OPKO Health (BioReference)', test_name: '4Kscore', aliases: ['4K score', '4Kscore Test'], coverage_topic: 'Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer' },
+];
+
+export const norm = (s: string) => s.toLowerCase().replace(/[®™]/g, '').replace(/[^a-z0-9]/g, '');
+
+type Named = { code: string; test_name: string; aliases: string[]; lab: string };
+
+/**
+ * Match free text to rows: by code, then exact name/alias, then containment
+ * (either way, longest name wins so "Oncotype DX colon" is colon, not breast),
+ * then lab. A name hit beats a lab hit.
+ */
+export function matchTests<T extends Named>(rows: T[], query: string): { matched_by: 'code' | 'test_name' | 'lab' | null; tests: T[] } {
+  const q = norm(query);
+  if (q.length < 3) return { matched_by: null, tests: [] };
+  const byCode = rows.filter((t) => norm(t.code) === q);
+  if (byCode.length) return { matched_by: 'code', tests: byCode };
+  const names = (t: T) => [t.test_name, ...t.aliases].map(norm);
+  const exact = rows.filter((t) => names(t).includes(q));
+  if (exact.length) return { matched_by: 'test_name', tests: exact };
+  const byName = rows.filter((t) => names(t).some((n) => n.length >= 4 && (n.includes(q) || q.includes(n))));
+  if (byName.length) {
+    const longest = Math.max(...byName.map((t) => Math.max(...names(t).filter((n) => q.includes(n)).map((n) => n.length), 0)));
+    const narrowed = longest > 0 ? byName.filter((t) => names(t).some((n) => n.length === longest && q.includes(n))) : byName;
+    return { matched_by: 'test_name', tests: narrowed };
+  }
+  const byLab = rows.filter((t) => q.length >= 4 && norm(t.lab).includes(q));
+  if (byLab.length) return { matched_by: 'lab', tests: byLab };
+  return { matched_by: null, tests: [] };
+}
+
+export interface GtrHit { code: string; test_name: string; lab: string; gtr_accession: string; url: string }
+
+/**
+ * NCBI GTR, live: tests whose registered name matches the query AND whose lab
+ * stated a CPT code. null when NCBI did not answer (distinct from "no hit").
+ */
+export async function gtrLookup(query: string, fetcher: typeof fetch): Promise<GtrHit[] | null> {
+  const q = norm(query);
+  if (q.length < 4) return [];
+  const base = 'https://eutils.ncbi.nlm.nih.gov/entrez/eutils';
+  const tool = '&tool=pipeworx&email=support%40pipeworx.io';
+  try {
+    const s = await fetcher(`${base}/esearch.fcgi?db=gtr&retmode=json&retmax=40&term=${encodeURIComponent(query)}${tool}`);
+    if (!s.ok) return null;
+    const ids = ((await s.json()) as { esearchresult?: { idlist?: string[] } }).esearchresult?.idlist ?? [];
+    if (!ids.length) return [];
+    const r = await fetcher(`${base}/esummary.fcgi?db=gtr&retmode=json&id=${ids.join(',')}${tool}`);
+    if (!r.ok) return null;
+    const res = ((await r.json()) as { result?: Record<string, any> }).result ?? {};
+    const hits: GtrHit[] = [];
+    for (const id of ids) {
+      const x = res[id];
+      if (!x || typeof x.testname !== 'string') continue;
+      const n = norm(x.testname);
+      if (!(n.includes(q) || (n.length >= 4 && q.includes(n)))) continue;
+      const codes = String(x.cptcode ?? '').split(/[^0-9A-Za-z]+/).map((c: string) => c.toUpperCase()).filter((c: string) => /^(\d{5}|\d{4}U)$/.test(c));
+      for (const code of codes) {
+        hits.push({ code, test_name: x.testname, lab: String(x.offerer ?? ''), gtr_accession: String(x.accession ?? ''), url: `https://www.ncbi.nlm.nih.gov/gtr/tests/${id}/` });
+      }
+    }
+    return hits;
+  } catch {
+    return null;
+  }
+}

package/src/index.ts

@@ -740,6 +740,7 @@ function collapse(s: string): string {
  */
 
 import { ADLT_DATA_AS_OF, ADLT_SOURCE_URL, SNAPSHOT_LAST_MODIFIED, matchAdlt, type AdltTest } from './adlt.js';
+import { BRAND_DATA_AS_OF, BRAND_SOURCE, BRAND_TESTS, gtrLookup, matchTests, norm as normName } from './brand-codes.js';
 
 // Bound every fetch() in this pack to a fixed timeout — an upstream that
 // degrades without erroring would otherwise hold the Worker in `await fetch()`
@@ -896,7 +897,7 @@ const tools: McpToolExport['tools'] = [
   {
     name: 'medicare_lab_test_lookup',
     description:
-      '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. Covers the tests on the CMS list of Advanced Diagnostic Laboratory Tests (ADLTs), the only public list that ties a test\'s brand name to its code; a test not on it returns not_found with the reason. Sourced from CMS (ADLT list, Clinical Laboratory Fee Schedule, Medicare Coverage Database).',
+      '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.',
     inputSchema: {
       type: 'object' as const,
       properties: {
@@ -1136,57 +1137,94 @@ async function callTool(name: string, args: Record<string, unknown>): Promise<un
       const test = typeof args.test === 'string' ? args.test.trim() : '';
       if (!test) return { found: false, reason: 'no_test', hint: 'Pass test, e.g. "Signatera".' };
       const includeRetired = args.include_retired === true;
-      const { matched_by, tests } = matchAdlt(test);
-      const [snapshot, coverage] = await Promise.all([adltSnapshotCheck(), tests.some((t) => t.coverage_topic) ? coverageIndex() : Promise.resolve(null)]);
+      // Sources in order (fleet #2458): the CMS ADLT list, then the MAAA brand
+      // table, then NCBI GTR live. The first that resolves answers; a miss
+      // names every source checked.
+      type Row = { code: string; test_name: string; lab: string; coverage_topic: string | null; code_source: string; adlt?: AdltTest; gtr?: { accession: string; url: string } };
+      const sourcesChecked: string[] = ['CMS ADLT list'];
+      let matched_by: string | null = null;
+      let rows: Row[] = [];
+      let sourceLabel = 'CMS list of Advanced Diagnostic Laboratory Tests (ADLTs) under the Medicare CLFS';
+      const adltHit = matchAdlt(test);
+      if (adltHit.tests.length) {
+        matched_by = adltHit.matched_by;
+        rows = adltHit.tests.map((t) => ({ code: t.code, test_name: t.test_name, lab: t.lab, coverage_topic: t.coverage_topic, code_source: 'CMS ADLT list', adlt: t }));
+      } else {
+        sourcesChecked.push('MAAA brand table (CPT Appendix O pairs backed by MolDX billing articles)');
+        const b = matchTests(BRAND_TESTS, test);
+        if (b.tests.length) {
+          matched_by = b.matched_by;
+          sourceLabel = BRAND_SOURCE;
+          rows = b.tests.map((t) => ({ code: t.code, test_name: t.test_name, lab: t.lab, coverage_topic: t.coverage_topic, code_source: 'MAAA brand table' }));
+        } else {
+          sourcesChecked.push('NCBI Genetic Testing Registry (live)');
+          const g = await gtrLookup(test, ((u: string) => pwFetch(u)) as unknown as typeof fetch);
+          if (g === null) sourcesChecked[sourcesChecked.length - 1] += ' — did not answer';
+          else if (g.length) {
+            matched_by = 'test_name';
+            sourceLabel = 'NCBI Genetic Testing Registry (GTR), code as registered by the performing lab';
+            const seen = new Set<string>();
+            rows = g.filter((h) => !seen.has(h.code + h.lab) && seen.add(h.code + h.lab)).slice(0, 10)
+              .map((h) => ({ code: h.code, test_name: h.test_name, lab: h.lab, coverage_topic: null, code_source: 'NCBI GTR (lab-reported)', gtr: { accession: h.gtr_accession, url: h.url } }));
+          }
+        }
+      }
+      const fromAdlt = rows.some((r) => r.adlt);
+      const [snapshot, coverage] = await Promise.all([
+        fromAdlt || !rows.length ? adltSnapshotCheck() : Promise.resolve({}),
+        rows.some((t) => t.coverage_topic) ? coverageIndex() : Promise.resolve(null),
+      ]);
       const provenance = {
-        source: 'CMS list of Advanced Diagnostic Laboratory Tests (ADLTs) under the Medicare CLFS; rates from the CMS Clinical Laboratory Fee Schedule; policies from the CMS Medicare Coverage Database',
-        source_url: ADLT_SOURCE_URL,
-        data_as_of: ADLT_DATA_AS_OF,
+        source: `${sourceLabel}; rates from the CMS Clinical Laboratory Fee Schedule; policies from the CMS Medicare Coverage Database`,
+        source_url: fromAdlt || !rows.length ? ADLT_SOURCE_URL : rows[0].gtr ? 'https://www.ncbi.nlm.nih.gov/gtr/' : 'https://www.cms.gov/medicare-coverage-database/',
+        data_as_of: fromAdlt || !rows.length ? ADLT_DATA_AS_OF : rows[0].gtr ? new Date().toISOString().slice(0, 10) : BRAND_DATA_AS_OF,
         ...snapshot,
       };
-      if (!tests.length) {
+      if (!rows.length) {
         return {
           found: false,
-          reason: 'not_on_adlt_list',
+          reason: 'brand_not_found',
           test,
-          hint: 'This test is not on CMS\'s ADLT list, which is the only public list that maps a lab test\'s brand name to its billing code. Most PLA codes are not ADLTs; the full PLA code list with proprietary names is published by the AMA under copyright. If you have the code (it usually ends in U, e.g. "0340U"), medicare_lab_rate gives its rate; medicare_lcd_search finds coverage policies by topic.',
+          sources_checked: sourcesChecked,
+          hint: `No billing code found for "${test}" in: ${sourcesChecked.join('; ')}. The full PLA code list with proprietary names is published by the AMA under copyright and is not used here. If you have the code (PLA codes end in U, e.g. "0340U"), medicare_lab_rate gives its rate; medicare_lcd_search finds coverage policies by topic.`,
           ...provenance,
         };
       }
-      const results = await Promise.all(tests.map(async (t: AdltTest) => {
+      const results = await Promise.all(rows.map(async (t) => {
         const rates = await pg<{ year: number; quarter: string; rate: number }>(cfg,
           `clfs_rates?hcpcs=eq.${t.code}&select=year,quarter,rate&order=year.desc,quarter.desc&limit=1`);
         // "Response to Comments" articles are the comment period's record, not policy.
-        const docs = t.coverage_topic && coverage
-          ? coverage.filter((d) => d.title.toLowerCase().includes(t.coverage_topic!.toLowerCase()) && !/^response to comments/i.test(d.title))
+        const topic = t.coverage_topic ? normName(t.coverage_topic) : '';
+        const docs = topic && coverage
+          ? coverage.filter((d) => normName(d.title).includes(topic) && !/^response to comments/i.test(d.title))
           : [];
         const active = docs.filter((d) => !d.retired);
         const retired = docs.filter((d) => d.retired);
+        const a = t.adlt;
         return {
           code: t.code,
-          ...(t.code_note ? { code_note: t.code_note } : {}),
+          ...(a?.code_note ? { code_note: a.code_note } : {}),
           test_name: t.test_name,
           lab: t.lab,
+          code_source: t.code_source,
+          ...(t.gtr ? { gtr: t.gtr } : {}),
           current_clfs_rate: rates.length
             ? { rate_usd: rates[0].rate, fee_schedule_year: rates[0].year, quarter: rates[0].quarter, note: 'National rate; the CLFS is not adjusted by locality.' }
             : { rate_usd: null, note: `${t.code} has no rate on the loaded Clinical Laboratory Fee Schedule (it may be contractor-priced).` },
-          adlt: {
-            approval_date: t.adlt_approval_date,
-            existing_adlt: t.existing_adlt,
-            new_adlt_initial_period: t.new_adlt_initial_period,
-            initial_period_payment_usd: t.initial_period_payment_usd,
-          },
+          adlt: a
+            ? { approval_date: a.adlt_approval_date, existing_adlt: a.existing_adlt, new_adlt_initial_period: a.new_adlt_initial_period, initial_period_payment_usd: a.initial_period_payment_usd }
+            : { is_adlt: false },
           coverage: t.coverage_topic
             ? {
                 policy_topic: t.coverage_topic,
-                topic_note: 'Policies whose title matches this test\'s category (our topic mapping, not CMS\'s). Whether this specific test is listed is stated in the billing article\'s code table.',
+                topic_note: 'Policies whose title matches this test or its category (our topic mapping, not CMS\'s). Whether this specific test is listed is stated in the billing article\'s code table.',
                 active_documents: active.slice(0, 20),
                 active_count: active.length,
                 ...(includeRetired ? { retired_documents: retired.slice(0, 20) } : {}),
                 retired_count: retired.length,
                 ...(coverage === null ? { error: 'CMS Coverage API did not answer; retry, or use medicare_lcd_search with the policy_topic.' } : {}),
               }
-            : { policy_topic: null, note: 'No MolDX local policy title matches this test\'s category; it may be covered nationally (NCD) or case by case.' },
+            : { policy_topic: null, note: 'No MolDX local policy title matched to this test; it may be covered nationally (NCD) or case by case — medicare_lcd_search can look.' },
         };
       }));
       return {
@@ -1194,7 +1232,8 @@ async function callTool(name: string, args: Record<string, unknown>): Promise<un
         query: test,
         matched_by,
         tests: results,
-        no_descriptors_note: 'The AMA\'s CPT PLA descriptor text is not returned (AMA copyright); the test name and lab are CMS\'s.',
+        sources_checked: sourcesChecked,
+        no_descriptors_note: 'The AMA\'s CPT descriptor text is not returned (AMA copyright); only the code, test name and lab.',
         ...provenance,
       };
     }

package/src/server.ts

@@ -9,7 +9,7 @@ import { CallToolRequestSchema, ListToolsRequestSchema } from '@modelcontextprot
 import pack from './index.js';
 
 const server = new Server(
-  { name: '@pipeworx/mcp-medicare-pricing', version: '0.1.2' },
+  { name: '@pipeworx/mcp-medicare-pricing', version: '0.1.3' },
   { capabilities: { tools: {} } },
 );