Server Instructions

An MCP server for accessing the CMS Coverage API v1 (Medicare Coverage Database). IMPORTANT - COVERAGE SCOPE: This server covers MEDICARE PART B (medical services) coverage policies only: • NCDs and LCDs govern Part B coverage for: procedures, DME, lab tests, injectable drugs administered in medical settings • NOT covered here: Part D (prescription drugs), Part A (inpatient hospital), Part C (Medicare Advantage) For oral prescription drugs (like TKIs, oral chemotherapy, etc.): • These are covered under Medicare Part D formularies, NOT NCDs/LCDs • FDA-approved oral anticancer drugs are generally covered by Part D plans • Coverage for these drugs is plan-specific (not in this database) TOOL CATEGORIES: NATIONAL COVERAGE TOOLS: - search_national_coverage: Search ALL national documents (NCDs, NCAs, CALs, Meetings, TAs) Set document_type='ncd'|'nca'|'cal'|'medcac'|'technology_assessment' LOCAL COVERAGE TOOLS: - search_local_coverage: Search ALL local documents (LCDs, Proposed LCDs, Articles) Set document_type='lcd'|'proposed_lcd'|'article' DETAIL RETRIEVAL TOOLS: - get_coverage_document: Get full details for a specialized document by type and ID - batch_get_ncds: Get multiple NCDs in a single call (up to 20) HELPER TOOLS: - get_contractors: Find Medicare Administrative Contractors by state - whats_new_national: Recent national coverage changes - whats_new_local: Recent local coverage changes - sad_exclusion_list: Self-Administered Drug Exclusion List MULTI-TOOL WORKFLOWS: For comprehensive coverage analysis: 1. Start with search_national_coverage(document_type='ncd') for national policies 2. Use get_contractors to find the relevant MAC for a geographic area 3. Use search_local_coverage(contractor_id=..., document_type='lcd') for local policies 4. Use search_local_coverage(document_type='article') for billing info 5. Check whats_new_national/local for recent policy changes For injectable/infused drug coverage: 1. Search national/local coverage for the drug class (document_type='ncd' or 'lcd') 2. Check for prior authorization requirements or coverage limitations 3. Search for alternative therapies in the same indication 4. Review LCD articles for specific J-code/HCPCS requirements SERVICES TYPICALLY COVERED BY NCDs/LCDs: • Durable Medical Equipment (wheelchairs, oxygen, CPAP) • Lab tests and diagnostic procedures • Outpatient procedures and surgeries • Injectable drugs administered by providers (J-codes) • Home health services • Preventive screenings SERVICES NOT IN THIS DATABASE: • Oral prescription drugs (Part D - check plan formularies) • Inpatient hospital stays (Part A) • Medicare Advantage plan-specific policies (Part C) Example queries this server can answer: - "What does Medicare cover for diabetes management?" -> use search_national_coverage(document_type='ncd') - "What is the LCD for home oxygen therapy in California?" -> use get_contractors + search_local_coverage(document_type='lcd') - "Find NCDs related to cardiac rehabilitation" -> use search_national_coverage(document_type='ncd') - "Are there recent updates to CGM coverage?" -> use whats_new_national - "Does Medicare cover Keytruda infusions?" -> search_national_coverage/search_local_coverage for immunotherapy/pembrolizumab Queries this server CANNOT answer (Part D): - "Is imatinib covered by Medicare?" -> Oral drug, covered by Part D plans - "What oral chemotherapy does Medicare cover?" -> Part D, not in this database