CMS Coverage

Name: CMS Coverage MCP Server
Availability: InStock
Author: CMS Coverage

Healthcare7 toolsNo Auth Required

Search Medicare Part B coverage policy — NCDs, LCDs and billing articles — from your AI agent. 7 read-only tools, no sign-in, built and operated by Anthropic. Published policy documents, never a claim decision.

Verified connector

Listed by Anthropic as an Anthropic-built connector in its Connectors Directory.

Connection checked by Agentman on 17 August 2026.

Anthropic states this reflects the level of review a connector received, not a security audit.

Connect CMS Coverage via MCP

https://hcls.mcp.claude.com/cms_coverage/mcp

Works in any MCP-compatible client. In Agentman Studio it is one click — no config file to edit.

CMS Coverage Tools & Capabilities (7)

search_national_coverageRead-only

Search national Medicare coverage documents (NCDs, NCAs, CALs, Meetings, Assessments). Unified tool for all national coverage queries. Supports pagination with cursor tokens.

search_local_coverageRead-only

Search local Medicare coverage documents (LCDs, Proposed LCDs, Articles). Unified tool for all local/regional coverage policies. Supports pagination with cursor tokens.

get_coverage_documentRead-only

Get full details for a specific coverage document by type and ID.

get_contractorsRead-only

Look up Medicare Administrative Contractors (MACs) - the companies that process Medicare Part B claims. **CONTEXT:** MACs administer Part B claims and create LCDs for Part B services in their jurisdictions. Part D prescription drugs are managed by Part D plan sponsors, not MACs. MACs are private companies contracted by CMS to process Medicare Part A and Part B claims and develop Local Coverage Determinations (LCDs). **When to use this tool:** - To get a list of all Medicare contractors and their IDs - To look up a specific contractor by ID - To find contractor_id values for use in LCD/Article searches **What you'll get:** - Contractor ID (needed for LCD/Article searches) - Contractor name (e.g., 'CGS Administrators, LLC') - Contract number **Note:** The API does not provide state-to-contractor mapping. To find LCDs for a specific state, search LCDs by keyword and review the contractor_name_type field in the results to identify the relevant regional contractor. **Example workflow:** 1. get_contractors() → list all contractors 2. search_lcds(keyword='oxygen') → find LCDs across all contractors 3. Filter results by contractor_name_type to find regional coverage

get_whats_new_reportRead-only

Get recently published or updated Medicare coverage documents (national or local). Unified tool for tracking policy changes. Supports pagination with cursor tokens.

batch_get_ncdsRead-only

Retrieve detailed information for multiple National Coverage Determinations (NCDs) in a single call. This tool efficiently fetches up to 20 NCDs at once, eliminating the need for multiple separate API calls when analyzing related coverage policies (e.g., all NCDs for diabetes, cardiac conditions, etc.). **When to use this tool:** - After using search_ncds to find multiple relevant NCDs - When comparing coverage policies across related conditions - When building comprehensive coverage summaries - Anytime you need details for 2+ NCDs **COVERAGE SCOPE:** NCDs are Part B policies for medical services, DME, injectables - not Part D drugs. **What you'll get:** - Complete NCD policy details for each document (indications_limitations, item_service_description) - Per-document success/failure status - Error details for any documents that failed to fetch **Workflow:** search_ncds(keyword='cardiac') → collect document_ids → batch_get_ncds(document_ids=[...]) → full details for all

sad_exclusion_listRead-only

Search the Self-Administered Drug (SAD) Exclusion List - drugs that CANNOT be billed under Medicare Part B. Supports pagination with cursor tokens for large result sets. **CRITICAL CONCEPT - WHAT IS THE SAD EXCLUSION LIST?** This list identifies drugs that are EXCLUDED from Part B billing because they are self-administered: • Part B covers drugs administered BY healthcare providers (injections, infusions in clinics) • Part B does NOT cover self-administered drugs (oral pills, self-injections at home) • Self-administered drugs are covered by Part D (prescription drug plans) **WHAT THIS LIST TELLS YOU:** If a drug is on this list, it means: • The drug is typically self-administered (oral, subcutaneous self-injection, etc.) • The drug CANNOT be billed under Part B • The drug would be covered under Part D instead **EXAMPLES OF SAD (EXCLUDED FROM PART B):** • Oral medications (tablets, capsules) - e.g., oral chemotherapy • Self-injectable biologics (e.g., adalimumab/Humira, etanercept/Enbrel) • Insulin and diabetic supplies for home use **NOT SAD (BILLABLE UNDER PART B):** • Provider-administered infusions (e.g., IV chemotherapy) • Injections given in physician offices • DME-related drugs administered via equipment **WHEN TO USE THIS TOOL:** • To verify if a specific drug can be billed under Part B • To check if a J-code drug is self-administered (excluded) • When researching billing options for injectable medications • To understand why a drug claim was denied under Part B **LICENSE:** License token is managed automatically - no manual token required.

Read from the server on 2026-08-17, including each tool's own safety annotations.

Limits

It answers about documents, never about people. No tool takes a patient, beneficiary, claim, plan or encounter parameter. Coverage of a specific claim is decided by a Medicare Administrative Contractor applying policy, documentation and medical necessity to that claim, with appeal rights attached. Do not paste patient information into a prompt — the connector has nowhere to put it.
Part B only. The server's own instructions restrict it to Part B medical services: procedures, durable medical equipment, lab tests and provider-administered injectable drugs. Part A inpatient hospital coverage, Part C Medicare Advantage rules and Part D prescription drug formularies are not in this database. Those instructions add that FDA-approved oral anticancer drugs are generally covered by Part D plans and that such coverage is plan-specific.
Retired and not-yet-effective policies come back in searches, and policies are revised in place. 120 of 975 documents in CMS's final-LCD report carried a Retired note on 2026-08-17, and 11 more were Future with a notice period running. Check effective_date, retirement_date and document_version on every result — one LCD in that sample was on version 30, and a citation without a version is ambiguous.
National policy can be very old. The 345 NCDs in CMS's national report on 2026-08-17 carry last-updated dates back to 2002, twelve of them at that year. Stability is by design, but do not infer currency from a search hit.
Keyword search matches titles only, and LCD full text is not retrievable. A term appearing only in a policy's body will not surface the document. search_local_coverage returns metadata and a CMS link; get_coverage_document has no lcd option. Local coverage criteria, documentation requirements and code lists must be read on the CMS website — which several sample prompts in Anthropic's tutorial ask for directly.
No state-to-contractor mapping. get_contractors returns IDs, names and contract numbers, and its description states the API provides no state mapping. CMS publishes the state-to-MAC table on its own site, and at least one state — Virginia — is split between two A/B MACs by county.
Third-party licence terms attach to the content. Anthropic's directory entry and tutorial both warn that data returned may be governed by third-party licence agreements, published at api.coverage.cms.gov/v1/metadata/license-agreement/. That document carries the AMA's CPT licence — which authorises personal, non-commercial use only and prohibits resale, redistribution and derivative works without a licence from the AMA — plus ADA CDT and AHA NUBC UB-04 terms, and AMA disclaimers of warranty. Connecting to the server is agreement to abide by them.
Anthropic calls the healthcare bundle experimental. Its own README states the plugin is provided as-is for evaluation against test or sandbox systems, is not validated for clinical use, is not a medical device, and should not drive patient-care or coverage decisions without qualified human review.
The tutorial names tools that do not exist. Fourteen tool names in Anthropic's own tutorial, and eight in its directory entry, do not match the seven the server returns. See Sources.
No tool writes anything. All seven are annotated read-only, non-destructive and idempotent. The connector cannot amend a determination, submit a public comment, file a claim or request an NCD.
We did not call any tool. Our check was a read-only initialize and tools/list handshake. Everything above about tool behaviour comes from the server's own descriptions and schemas plus Anthropic's published tutorial. The corpus counts come from CMS's own API, not from this connector.

Frequently asked questions

Can the CMS Coverage connector tell me whether Medicare will pay for my procedure?

No. It retrieves published coverage policy documents — the NCDs, LCDs and billing articles CMS puts in the Medicare Coverage Database. No tool on this server takes a patient, a claim, a diagnosis or a plan identifier, so nothing it returns is a determination about any individual. Whether a specific claim is paid is decided by a contractor applying policy to that claim.

Who built and operates this connector, and whose data is it?

Anthropic built the connector, operates the endpoint on its own infrastructure at hcls.mcp.claude.com, and lists it at anthropic tier in its Connectors Directory. The data belongs to nobody at Anthropic. Every document comes from the Medicare Coverage Database that the Centers for Medicare & Medicaid Services maintains, reached through the CMS Coverage API v1.

Does the CMS Coverage connector need a sign-in or an API key?

No. We opened an anonymous handshake against the endpoint on 2026-08-17 and it returned all seven tool definitions with no credential of any kind. Anthropic's directory records the server as authless, and the host publishes no OAuth protected-resource descriptor. The sad_exclusion_list tool states that its licence token is managed automatically, so no manual token is needed.

Does a document returned by the connector mean that policy is currently in force?

Not necessarily, and this is the trap. CMS's own final-LCD report held 975 documents on 2026-08-17, of which 120 carried a Retired note and 11 were flagged Future with a notice period still running. Read every result's effective date and retirement date before relying on it, and treat a hit as a document, not as the operative rule.

Can the connector read the full text of a Local Coverage Determination?

No, and the schemas are explicit about it. search_local_coverage returns LCD and article metadata only — title, contractor, version, effective and retirement dates, and a link to the CMS website. get_coverage_document accepts ncd, nca and cal document types, not lcd. Full NCD policy text is available; LCD coverage criteria must be read on the CMS site.

Why does a keyword search miss a policy I know exists?

Because the keyword parameter on both search tools filters by document title only, as their schemas state. A policy whose criteria mention a drug or a code will not match unless that term appears in its title. Search broadly on the clinical topic, page through results, and open documents on the CMS site to search their body text.

Does this connector cover Medicare Part A, Part C or Part D?

No. The server's own instructions state it covers Part B medical services only — procedures, durable medical equipment, lab tests and provider-administered injectable drugs. Part A inpatient hospital coverage, Part C Medicare Advantage plan rules and Part D prescription drug formularies are outside the Medicare Coverage Database and outside this connector entirely.