{
  "name": "medicare-prior-auth-mcp",
  "title": "HealthMesh · Medicare Prior Authorization MCP",
  "version": "0.1.1",
  "description": "Medicare fee-for-service prior authorization lists from CMS: check whether a HCPCS/CPT code needs prior authorization in a state on a date under the DMEPOS Required Prior Authorization List, the Hospital OPD services program, the WISeR Model (AZ, NJ, OH, OK, TX, WA) or the RSNAT ambulance model, list a program's codes, and get program rules and contacts. CPT codes are identifiers only (no AMA descriptors).",
  "healthmesh_domain": "Utilization Management",
  "datasets": [
    "UM-03",
    "UM-04"
  ],
  "mcp_endpoint": "https://medicare-prior-auth.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/medicare-prior-auth-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "CMS prior authorization code lists (DMEPOS Required Prior Authorization List, OPD services list, WISeR Model guide Appendix A)",
    "url": "https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-and-pre-claim-review-initiatives",
    "license": "U.S. Government works (CMS); CPT codes used as identifiers only, no AMA descriptors",
    "refresh": "monthly SHA-256 check of the CMS PDFs; rebuilt on change"
  },
  "tools": [
    {
      "name": "pa_check_code",
      "title": "Does a code need Medicare prior authorization?",
      "description": "Checks whether a HCPCS Level II or CPT code requires Original Medicare (fee-for-service) prior authorization in a state on a date, across the DMEPOS Required Prior Authorization List, the Hospital OPD services program, the WISeR Model (AZ, NJ, OH, OK, TX, WA, 2026-2031) and the RSNAT ambulance model. Returns each matching program with the decision basis, effective dates/phases, conditions and the CMS source. requires_pa is true, false, 'conditional' (applies only for certain indications or use) or 'depends_on_state'."
    },
    {
      "name": "pa_list_codes",
      "title": "List codes on a Medicare prior authorization list",
      "description": "Lists the codes on one CMS prior authorization program list (dmepos, opd, wiser, rsnat) with category, effective dates or phases and, for HCPCS Level II codes, the CMS descriptor. Optional filters: category text, state and date (only codes requiring prior authorization there and then)."
    },
    {
      "name": "pa_get_program",
      "title": "Medicare prior authorization program details",
      "description": "Returns a CMS fee-for-service prior authorization / pre-claim review program's rules: legal authority, who must request, states and timeline, review turnaround, contractors (WISeR participants and MACs by state), notes and source links. Programs: dmepos, opd, wiser, rsnat, rcd (home health Review Choice Demonstration). Omit program for a one-line summary of each."
    },
    {
      "name": "pa_describe_dataset",
      "title": "Describe the prior authorization data",
      "description": "Explains the CMS source documents, their versions and SHA-256 checksums, code counts per program, how the lists were parsed, the licensed-text policy (no CPT descriptors) and the main caveats."
    }
  ]
}