CMS Coverage Connector#
The CMS Coverage Connector gives Claude access to Medicare Part B coverage policies from the CMS Coverage Database, including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).
What You Can Do#
With this connector, Claude can help you:
Search Medicare Part B coverage policies
Find National and Local Coverage Determinations
Review billing and coding guidance articles
Check coverage criteria for procedures and services
Track recent policy changes
Identify Medicare Administrative Contractors by state
Data Source: CMS Coverage Database API v1
MCP Endpoint: https://mcp.deepsense.ai/cms_coverage/mcp
Important: Covers Medicare Part B only (medical services, not prescription drugs)
Getting Started#
Adding the Connector to Claude#
Open Claude’s Connector Settings
In Claude Desktop, select your profile icon in the bottom left
Navigate to Settings → Connectors
Find the CMS Coverage Connector
Browse the available connectors catalogue
Search for “CMS Coverage” or find it under Healthcare connectors
Enable the Connector
Click on the CMS Coverage Connector
Click “Enable” or “Add Connector”
The connector will be activated immediately
No authentication required - the connector works immediately after enabling
Verify the Connection
Ask Claude: “Does Medicare cover PET scans?”
Claude should use the CMS Coverage connector to search policies
What Medicare Part B Covers#
This connector includes:
Medical services (physician visits, outpatient care)
Injectable and infused drugs given in medical settings
Durable Medical Equipment (DME)
Laboratory tests and diagnostics
Home health services
Preventive screenings
NOT included in this connector:
Part D: Oral prescription drugs
Part A: Inpatient hospital services
Part C: Medicare Advantage plans
Medicaid or private insurance policies
Available Tools#
National Coverage Tools#
1. Search NCDs#
What it does: Searches National Coverage Determinations - national Medicare policies that apply to all beneficiaries.
Use it for:
Finding national coverage policies
Checking coverage for new technologies
Understanding Medicare’s position on treatments
Researching coverage criteria
Example queries:
“Does Medicare cover PET scans?”
“Find NCDs for genetic testing”
“Search for diabetes coverage policies”
“What’s Medicare’s policy on bariatric surgery?”
What Claude will do:
Search NCDs by keyword
Return matching national policies
Provide NCD numbers and titles
Include links to full policy documents
Show effective dates
2. Get NCD Details#
What it does: Retrieves complete information for a specific National Coverage Determination.
Use it for:
Reading full policy text
Understanding coverage criteria
Checking indications and limitations
Finding coding requirements
Example queries:
“Show me details for NCD 220.6”
“Get the full text of the PET scan NCD”
“What are the coverage criteria in NCD 190.14?”
What Claude will do:
Retrieve the complete NCD document
Present coverage criteria and limitations
Show coding information
Provide effective dates
Include transmittal references
3. Search Coverage Analyses#
What it does: Finds National Coverage Analyses (NCAs) and Coverage Analysis Letters (CALs) - documents explaining coverage decisions.
Use it for:
Understanding coverage decision rationale
Tracking proposed policies
Reviewing evidence behind decisions
Monitoring policies under development
Example queries:
“Find NCAs for cardiac devices”
“Search for proposed coverage analyses”
“What coverage letters exist for gene therapy?”
What Claude will do:
Search NCAs and CALs
Show analysis status and decisions
Provide decision rationale
Link to related NCDs
Local Coverage Tools#
4. Search LCDs#
What it does: Searches Final Local Coverage Determinations - regional policies by Medicare Administrative Contractors.
Use it for:
Finding local/regional coverage policies
Checking state-specific requirements
Understanding local medical necessity criteria
Finding policies without national determinations
Example queries:
“Search LCDs for physical therapy in California”
“Find local coverage for wound care in Texas”
“What LCDs exist for genetic testing in New York?”
What Claude will do:
Search LCDs by keyword
Filter by state if specified
Return matching local policies
Show which MACs issued the policies
Provide effective dates
5. Search Proposed LCDs#
What it does: Finds Local Coverage Determinations pending implementation.
Use it for:
Preparing for upcoming changes
Commenting during public comment periods
Planning workflow updates
Tracking policy development
Example queries:
“Find proposed LCDs in my state”
“What coverage changes are coming?”
“Search for proposed policies on genetic testing”
What Claude will do:
Search proposed LCDs
Show anticipated effective dates
Indicate comment period information
Describe changes from current policy
6. Search Articles#
What it does: Searches Local Coverage Articles - detailed billing and coding guidance documents.
Use it for:
Finding covered diagnosis codes
Checking applicable procedure codes
Understanding documentation requirements
Getting specific billing instructions
Example queries:
“Find billing article for LCD L12345”
“What ICD-10 codes are covered for physical therapy in California?”
“Search articles for wound care documentation requirements”
What Claude will do:
Search billing articles
Find covered ICD-10 diagnosis codes
List applicable CPT/HCPCS procedure codes
Provide documentation requirements
Link to related LCDs
Policy Tracking Tools#
7. What’s New - National#
What it does: Tracks recent national coverage changes and updates.
Use it for:
Monitoring policy changes
Staying current on NCDs
Tracking new technologies
Identifying policy revisions
Example queries:
“What national coverage policies changed recently?”
“Show me new NCDs from the past 30 days”
“Have there been updates to genetic testing policies?”
What Claude will do:
Retrieve recent national policy changes
Show new and revised NCDs, NCAs, CALs
Indicate effective dates
Provide change descriptions
8. What’s New - Local#
What it does: Tracks recent local coverage changes by region.
Use it for:
Monitoring regional policy changes
Tracking LCD updates in your state
Staying current on local policies
Planning for policy implementations
Example queries:
“What coverage policies changed in California recently?”
“Show me new LCDs from the past 60 days”
“Have there been updates in Texas?”
What Claude will do:
Retrieve recent local policy changes
Filter by state if specified
Show new and revised LCDs and articles
Indicate effective dates
Support Tools#
9. Get Contractors#
What it does: Finds Medicare Administrative Contractors (MACs) by state.
Use it for:
Identifying which MAC covers your state
Finding MAC contact information
Determining applicable local policies
Understanding jurisdiction coverage
Example queries:
“Which Medicare contractor handles California?”
“Find the MAC for Texas”
“Who processes Medicare claims in New York?”
What Claude will do:
Identify the MAC for the specified state
Provide contractor name and ID
Show jurisdiction information
List states covered by the MAC
10. SAD Exclusion List#
What it does: Provides the Self-Administered Drug (SAD) Exclusion List - drugs not covered under Part B.
Use it for:
Verifying if a drug is Part B covered
Avoiding claim denials
Determining correct benefit category
Guiding patients to Part D coverage
Example queries:
“Is this drug covered under Part B?”
“Show me the SAD exclusion list”
“Why was this drug denied under Part B?”
What Claude will do:
Search the SAD exclusion list
Identify excluded drugs by name or HCPCS code
Explain why drugs are excluded
Indicate Part D coverage alternative
Additional Tools#
The connector also includes:
Search MEDCAC Meetings: Find Medicare Evidence Development & Coverage Advisory Committee meetings
Search Technology Assessments: Access formal technology evaluations
Get NCA/CAL Details: Retrieve complete analysis documents
Usage Examples#
Example 1: Checking Coverage for a Procedure#
You: “Does Medicare Part B cover genetic testing for breast cancer?”
Claude will:
Use Search NCDs to check for national policies on genetic testing
If found, use Get NCD Details to show full coverage criteria
If no NCD, use Search LCDs to check for local policies
Use Search Articles to find covered diagnosis codes
Explain coverage criteria and any limitations
Example 3: Staying Current on Policy Changes#
You: “Have there been any Medicare coverage changes in the last month that affect my practice?”
Claude will:
Use What’s New - National to check recent NCD changes
Use What’s New - Local with your state to check LCD updates
Summarize new and revised policies
Highlight policies relevant to your specialty
Note effective dates for upcoming changes
Need Help?#
For issues or questions about the CMS Coverage Connector, see our Troubleshooting Guide.