{
  "name": "ncci-edits-mcp",
  "title": "HealthMesh · NCCI Edits MCP",
  "version": "0.1.1",
  "description": "CMS National Correct Coding Initiative (NCCI) edits from CMS's public files: Medicaid NCCI procedure-to-procedure (PTP) edits for practitioner, outpatient hospital and DME services (2026-Q4 files with effective/deletion-date history) and Medically Unlikely Edits (MUEs) for Medicare and Medicaid (2026-Q4). Medicare PTP tables are not served (CMS distributes them only behind an AMA CPT license click-through). Codes only, no CPT descriptors.",
  "healthmesh_domain": "Claims & Payments",
  "datasets": [
    "CLM-10"
  ],
  "mcp_endpoint": "https://ncci-edits.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/ncci-edits-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "CMS Medicaid NCCI PTP + MUE edit files 2026-Q4, Medicare NCCI MUE tables 2026-Q4",
    "url": "https://www.cms.gov/medicare/coding-billing/ncci-medicaid/medicaid-ncci-edit-files",
    "license": "U.S. Government work, public domain (CPT codes as identifiers only)",
    "refresh": "quarterly (bundled; GitHub Actions checks the CMS pages weekly)"
  },
  "tools": [
    {
      "name": "ncci_check_ptp_pair",
      "title": "Check an NCCI PTP code pair",
      "description": "Checks whether two HCPCS/CPT codes form an NCCI procedure-to-procedure (PTP) edit in the Medicaid NCCI files for a setting, in either order, and whether it is in force on a date of service. Returns which code is column 1 (payable) and column 2 (denied unless bypassed), the modifier indicator (0 not allowed, 1 allowed, 9 n/a), effective/deletion dates and CMS's rationale. Medicare PTP tables are not served (AMA license gate)."
    },
    {
      "name": "ncci_get_mue",
      "title": "Get the MUE for a code",
      "description": "Returns the published Medically Unlikely Edit (MUE) for a HCPCS/CPT code: the maximum units of service per beneficiary per date of service by the same provider, the MUE adjudication indicator (Medicare: 1 line, 2 date-of-service policy, 3 date-of-service clinical) and CMS's rationale, for Medicare or Medicaid and the practitioner, outpatient hospital or DME setting (2026-Q4 files). Values for the other settings are listed for comparison."
    },
    {
      "name": "ncci_validate_claim_lines",
      "title": "Validate claim lines against NCCI",
      "description": "Checks 1-50 claim lines (code, modifiers, units) for one patient, provider and date of service: every code pair is checked against Medicaid NCCI PTP edits (whether an NCCI-associated modifier such as 59/XU/XS/LT/RT/25 is present on the column 2 line when the edit allows one), and units against the Medicare or Medicaid MUE (line-level or summed per date of service per the MAI). Medicare PTP edits are not checked (AMA license gate)."
    },
    {
      "name": "ncci_list_edits_for_code",
      "title": "List NCCI PTP edits for a code",
      "description": "Lists the Medicaid NCCI PTP edits where a code is column 1 (codes bundled into it), column 2 (codes it bundles into) or both, for a setting, in force on a date of service (default today) or including deleted history. Paged; Medicare PTP tables are not served (AMA license gate)."
    },
    {
      "name": "ncci_describe_dataset",
      "title": "Describe the NCCI data",
      "description": "Explains which CMS NCCI files are loaded (programs, settings, quarter, row counts), how PTP dates, modifier indicators and MUE adjudication indicators work, and what is not covered (Medicare PTP tables behind the AMA license gate, add-on code edits, prior quarters' MUEs)."
    }
  ]
}