NCCI Claims Validation — CPT Code Pair Edits + MUE Limits
@easysolutions906
Validate CPT/HCPCS code pairs against NCCI edits. Check if codes can be billed together, what modifiers are needed, and MUE unit limits. Prevents claim denials. No public API like this exists.
概要
What is NCCI Claims Validation — CPT Code Pair Edits + MUE Limits?
A Model Context Protocol (MCP) server that validates CPT/HCPCS code pairs against CMS National Correct Coding Initiative (NCCI) edits. It checks Procedure-to-Procedure (PTP) bundling edits and Medically Unlikely Edits (MUE) to help prevent claim denials for medical billers and compliance teams.
How to use NCCI Claims Validation — CPT Code Pair Edits + MUE Limits?
Install and run via npx @easysolutions906/ncci-api. Configure as an MCP server in Claude Desktop (claude_desktop_config.json) or Cursor (.cursor/mcp.json). Optionally run as an HTTP server by setting the PORT environment variable. Use the provided tools (ncci_validate_pair, ncci_validate_claim, ncci_edits, ncci_mue, ncci_search) to perform validations.
Key features of NCCI Claims Validation — CPT Code Pair Edits + MUE Limits
- Five MCP tools for pair, claim, code edits, MUE, and search
- Covers 20+ medical specialties (allergy to wound repair)
- Returns modifier requirements, edit status, and rationale
- Free tier (20 validations/day) with paid plans up to 50,000/day
- Supports stdio (local) and HTTP (Streamable HTTP) transports
- Audit trail with data version, build date, and timestamp
Use cases of NCCI Claims Validation — CPT Code Pair Edits + MUE Limits
- Checking if two CPT codes can be billed together before claim submission
- Validating an entire claim for all PTP edits and MUE violations
- Looking up all NCCI edits for a specific code and its bundled pairs
- Determining the maximum units allowed per code (MUE limits)
- Searching edits by code, procedure name, or category
FAQ from NCCI Claims Validation — CPT Code Pair Edits + MUE Limits
How does this differ from using raw CMS NCCI files?
It provides instant, programmatic validation with clear modifier guidance instead of requiring manual parsing of quarterly CMS data.
What are the dependencies and runtime requirements?
Requires Node.js and npx. The server runs locally via stdio or can be deployed as an HTTP server.
Where does the NCCI data live, and is it updated?
Data is bundled with the server and covers multiple specialties. It can be updated by running npm run build-data. Each response includes the CMS quarter (dataVersion) and build date.
What transports and authentication are available?
Default transport is stdio; set PORT env var for Streamable HTTP mode on /mcp. HTTP servers optionally require an ADMIN_SECRET for the checkout and admin endpoints. The MCP tools themselves do not require authentication.
Are there any usage limits?
Yes. The free plan allows 20 validations per day with 5 per minute rate. Paid plans remove those limits (Starter: 500/day, Pro: 5,000/day, Business: 50,000/day).
