Medicare Coverage
live HealthGovernmentUSSearch current Medicare National Coverage Determinations (NCDs) by title, benefit category, or NCD number.
Tools
medicare_ncd_search 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 docum
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medicare_ncd_detail 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
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medicare_lcd_search Search current final Medicare Local Coverage Determinations (LCDs), optionally restricted to a state. LCDs are contractor- and jurisdiction-specific and can differ across locations.
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medicare_lcd_detail 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 ob
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medicare_nca_search 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.
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medicare_nca_detail 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.
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medicare_recent_coverage_changes Recently published or updated national Medicare coverage documents from CMS, including NCDs, NCAs, CALs, MEDCAC meetings, and technology assessments.
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medicare_coverage_states List CMS Coverage API state identifiers used to scope local Medicare coverage searches.
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medicare_article_code_profile 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
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medicare_local_coverage_variation 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
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medicare_coverage_timeline 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
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medicare_hcpcs_utilization_trend 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
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medicare_hcpcs_geography 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
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medicare_provider_exposure 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
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medicare_product_market_profile 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 w
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medicare_part_d_top_drugs 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 dru
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medicare_part_d_drug_spending 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
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medicare_part_d_prescriber_exposure 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 prescribe
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medicare_part_d_generic_competition 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 co
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medicare_inpatient_drg_market 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 payment
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medicare_outpatient_apc_market 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
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medicare_hospital_service_trend 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 Advantag
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medicare_dme_supplier_market 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
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medicare_dme_service_trend 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 o
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medicare_post_acute_provider_market 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
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medicare_post_acute_trend 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 th
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medicare_enrollment_trend 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 participa
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Test with curl
The gateway speaks JSON-RPC 2.0 over HTTP POST. You can test any pack directly from the terminal.
curl -X POST https://gateway.pipeworx.io/medicare-coverage/mcp \
-H "Content-Type: application/json" \
-d '{"jsonrpc":"2.0","id":1,"method":"tools/list"}'curl -X POST https://gateway.pipeworx.io/medicare-coverage/mcp \
-H "Content-Type: application/json" \
-d '{"jsonrpc":"2.0","id":2,"method":"tools/call","params":{"name":"medicare_ncd_search","arguments":{}}}'Use with the SDK
Install @pipeworx/sdk to call tools from any TypeScript/Node project.
import { Pipeworx } from '@pipeworx/sdk';
const px = new Pipeworx();
const result = await px.call("medicare_ncd_search", {});// Or ask in plain English:
const answer = await px.ask("search current medicare national coverage determinations (ncds) by title, benefit category, or ncd number");