🏥 Medical Billing MCP

Open-source billing knowledge for AI assistants

The Problem: A billing staff member gets a denial code. They Google it, read 5 articles, call the payer, wait on hold for 45 minutes, and maybe get an answer. Cost: 30-60 minutes per denial.

The Solution: Ask an AI assistant. Get instant answers with resolution steps. Cost: 2 minutes.

What Is This?

An MCP (Model Context Protocol) server that gives AI assistants like Claude access to medical billing knowledge:

Tool	What It Does
`lookup_icd10`	Look up diagnosis codes
`lookup_cpt`	Look up procedure codes
`lookup_modifier`	Understand when to use modifiers (25, 59, etc.)
`lookup_denial`	Understand denial codes + how to fix them
`lookup_payer`	Get payer-specific rules (timely filing, etc.)
`lookup_bundling`	Check if codes are bundled together

This is a knowledge layer. You bring your own payer connectivity (Stedi, Availity, Change Healthcare, etc.).

Quick Start

Option 1: Docker (Recommended)

# Clone the repo
git clone https://github.com/Kustode-ce/medical-billing-mcp.git
cd medical-billing-mcp

# Run with Docker
docker compose up -d

# Test it
docker compose exec mcp python -m medical_billing_mcp --test

Option 2: Local Install

# Clone and install
git clone https://github.com/Kustode-ce/medical-billing-mcp.git
cd medical-billing-mcp
pip install -e .

# Run the server
python -m medical_billing_mcp

Configure Claude Desktop

Add to your claude_desktop_config.json:

{
  "mcpServers": {
    "medical-billing": {
      "command": "python",
      "args": ["-m", "medical_billing_mcp"]
    }
  }
}

Config locations:

macOS: ~/Library/Application Support/Claude/claude_desktop_config.json
Windows: %APPDATA%\Claude\claude_desktop_config.json
Linux: ~/.config/Claude/claude_desktop_config.json

Restart Claude Desktop.

Usage Examples

Once installed, ask Claude questions like:

Understanding Codes

"What does ICD-10 code E11.9 mean?"

"What's CPT code 99214 and what documentation do I need?"

"When should I use modifier 25?"

Resolving Denials

"I got denial code CO-50. What does it mean and how do I fix it?"

"My claim was denied for 'not medically necessary'. What are the resolution steps?"

Payer Rules

"What's Medicare's timely filing limit?"

"What are Blue Cross MA's known billing issues?"

Bundling

"Are CPT codes 99213 and 36415 bundled?"

See docs/examples/ for sample conversations.

Architecture

┌─────────────────────────────────────────────────────────────────┐
│                    AI ASSISTANT (Claude)                         │
└─────────────────────────────────────────────────────────────────┘
                              │
                              │ MCP Protocol
                              ▼
┌─────────────────────────────────────────────────────────────────┐
│                    MEDICAL BILLING MCP                           │
│                                                                  │
│  ┌──────────────────────────────────────────────────────────┐  │
│  │                      server.py                            │  │
│  │            (Tool definitions + routing)                   │  │
│  └──────────────────────────────────────────────────────────┘  │
│                              │                                   │
│  ┌──────────────────────────────────────────────────────────┐  │
│  │                     handlers.py                           │  │
│  │              (Lookup functions)                           │  │
│  └──────────────────────────────────────────────────────────┘  │
│                              │                                   │
│  ┌──────────────────────────────────────────────────────────┐  │
│  │                       data/                               │  │
│  │                                                           │  │
│  │   icd10.json   cpt.json   modifiers.json                 │  │
│  │   denials.json   payers.json   bundling.json             │  │
│  │                                                           │  │
│  │            [Community contributes here]                   │  │
│  └──────────────────────────────────────────────────────────┘  │
└─────────────────────────────────────────────────────────────────┘

See ARCHITECTURE.md for detailed design documentation.

What This Is NOT

Not In Scope	Why	You Already Have
Claim submission	Not our job	Stedi, Availity
Eligibility checks	Real-time payer data	Stedi, payer portals
Prior auth submission	Payer integration	Cohere, eviCore
EOB/ERA parsing	Clearinghouse function	Stedi, clearinghouse
PHI storage	Security/compliance	Your EHR/PMS

We provide knowledge. You provide connectivity.

Data Sources

All data is from public sources:

Data	Source
ICD-10 codes	CMS
CPT descriptions	AMA (limited - full requires license)
HCPCS codes	CMS
Denial codes (CARC/RARC)	X12 / Washington Publishing
Payer rules	Public payer manuals

Contributing

We welcome contributions! The easiest way to help:

Add Payer Rules

Know a payer's quirks? Edit data/payers.json:

{
  "bcbs_tx": {
    "name": "Blue Cross Blue Shield Texas",
    "timely_filing_days": 95,
    "known_issues": ["Requires modifier 25 documentation"]
  }
}

Add Denial Resolution Steps

Fixed a tricky denial? Share how in data/denials.json:

{
  "CO-151": {
    "description": "Service not covered",
    "resolution_steps": [
      "Check if service requires prior auth",
      "Verify correct place of service code",
      "Appeal with medical necessity documentation"
    ]
  }
}

See CONTRIBUTING.md for full guidelines.

Project Structure

medical-billing-mcp/
├── src/medical_billing_mcp/
│   ├── __init__.py
│   ├── __main__.py
│   ├── server.py          # MCP server
│   ├── handlers.py        # Lookup functions
│   └── data/              # JSON knowledge base
│       ├── icd10.json
│       ├── cpt.json
│       ├── modifiers.json
│       ├── denials.json
│       ├── payers.json
│       └── bundling.json
├── tests/
├── docs/
│   ├── diagrams/          # Architecture diagrams
│   ├── api/               # API documentation
│   └── examples/          # Usage examples
├── docker/
│   ├── Dockerfile
│   └── docker-compose.yml
├── ARCHITECTURE.md
├── CONTRIBUTING.md
├── LICENSE
└── README.md

License

MIT License - see LICENSE

Note: CPT codes are copyrighted by the AMA. This tool provides limited descriptions for educational purposes. For full CPT data, obtain an AMA license.

Support

🐛 Issues: GitHub Issues
💬 Discussions: GitHub Discussions

Made for the healthcare community ❤️

Because providers should spend time with patients, not fighting insurance companies.

medical-billing-mcp