{
  "name": "medicare-utilization-mcp",
  "title": "HealthMesh · Medicare Utilization & Payment (Part B, Inpatient, Outpatient, DMEPOS) MCP",
  "version": "0.1.1",
  "description": "Live CMS Medicare fee-for-service utilization and payment data from data.cms.gov: Physician & Other Practitioners (Part B) by provider and service, by provider and by geography and service (2013-2024); Inpatient Hospitals by provider and MS-DRG (2013-2024); Outpatient Hospitals by provider and APC (2015-2024); DMEPOS by referring provider and service (2014-2024). Services, beneficiaries, average submitted/allowed/paid amounts, provider rankings, state/specialty/place-of-service comparisons and multi-year national or state trends.",
  "healthmesh_domain": "Claims & Payments",
  "datasets": [
    "CLM-01",
    "CLM-02",
    "CLM-03",
    "CLM-04"
  ],
  "mcp_endpoint": "https://medicare-utilization.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/medicare-utilization-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "CMS data.cms.gov Medicare Fee-For-Service provider utilization and payment data (Physician & Other Practitioners, Inpatient Hospitals, Outpatient Hospitals, DMEPOS by Referring Provider)",
    "url": "https://data.cms.gov/provider-summary-by-type-of-service",
    "license": "U.S. Government work, public domain",
    "refresh": "live (24 h edge cache); upstream annual"
  },
  "tools": [
    {
      "name": "partb_search_services",
      "title": "Search Part B services by provider",
      "description": "Searches Medicare Physician & Other Practitioners by Provider and Service (one row per rendering NPI x HCPCS code x place of service; data years 2013-2024) by HCPCS code, NPI, state, provider type and place of service. Returns beneficiaries, services and average submitted, allowed, paid and standardized amounts, ranked by services (or beneficiaries, average or total payment). Give npi or hcpcs_code. 'Who bills the most 99490 in Arizona?' = hcpcs_code 99490 + state AZ."
    },
    {
      "name": "partb_get_provider_profile",
      "title": "Part B provider profile",
      "description": "Returns one rendering provider's (NPI) Medicare Part B profile for a data year (2013-2024): practice details (type, location, RUCA, participation), totals (HCPCS codes, beneficiaries, services, submitted/allowed/paid/standardized amounts, drug vs medical split), beneficiary demographics, average HCC risk score and chronic-condition prevalence, plus the top HCPCS services by services or total Medicare payment."
    },
    {
      "name": "partb_compare_hcpcs",
      "title": "Compare a HCPCS code by state, specialty or place of service",
      "description": "Aggregates one HCPCS/CPT code's Medicare Part B volume and service-weighted average submitted, allowed and paid amounts by state, by place of service (facility vs office) or by provider type (specialty), nationally or within a state, for a data year 2013-2024. State and place-of-service views use CMS's Geography and Service file (complete); the provider-type view sums provider-level rows (rows under 11 beneficiaries are unpublished, so it is a lower bound)."
    },
    {
      "name": "inpatient_get_drg_by_hospital",
      "title": "Inpatient discharges by MS-DRG and hospital",
      "description": "Medicare Inpatient Hospitals by Provider and Service (data years 2013-2024): discharges, average covered charges, average total payment and average Medicare payment per MS-DRG for one hospital (CCN or name fragment), or for one DRG across hospitals in a state/city, ranked by discharges or payment. With a DRG, adds the national (and state) benchmark from CMS's geography file. E.g. 'Which Chicago hospitals treat the most sepsis?' = drg_code 871, state IL, city Chicago."
    },
    {
      "name": "outpatient_get_apc_by_hospital",
      "title": "Outpatient services by APC and hospital",
      "description": "Medicare Outpatient Hospitals by Provider and Service (data years 2015-2024): beneficiaries, services, average submitted charges, allowed and Medicare payment and outlier services per comprehensive APC, for one hospital (CCN or name fragment) or for one APC across hospitals in a state/city, ranked by services or payment, with national/state APC benchmarks. E.g. 'Which Texas hospitals do the most APC 5191?' = apc_code 5191, state TX."
    },
    {
      "name": "dme_search_referrers",
      "title": "Search DMEPOS by referring provider",
      "description": "Medicare DMEPOS by Referring Provider and Service (data years 2014-2024): per referring/ordering NPI x HCPCS x rental flag, the number of suppliers, beneficiaries, claims, services and average submitted, allowed and paid amounts, with CMS's RBCS category. Search by referring NPI, HCPCS code (e.g. K0823 power wheelchair, E0601 CPAP) or RBCS id, optionally in a state; ranked by services, claims, beneficiaries or payment."
    },
    {
      "name": "medicare_util_trend",
      "title": "Multi-year Medicare utilization trend for a code",
      "description": "Returns a national or state year-by-year series (from CMS's Geography and Service files) of volume, beneficiaries, average allowed and average Medicare payment and total Medicare payment for a Part B HCPCS/CPT code (2013-2024), an inpatient MS-DRG (2013-2024), an outpatient APC (2015-2024) or a DMEPOS HCPCS code (2014-2024), with year-over-year change and CAGR. E.g. telehealth 99441 volume, DRG 470 discharges 2015-2024."
    },
    {
      "name": "medicare_util_describe_dataset",
      "title": "Describe the Medicare utilization datasets",
      "description": "Lists the nine CMS data.cms.gov datasets behind this server (Physician & Other Practitioners by provider and service / provider / geography; Inpatient and Outpatient Hospitals by provider and by geography; DMEPOS by referring provider and by geography) with available data years, grain, suppression rules and which tool uses each."
    }
  ]
}