NCCI Claims Validation — CPT Code Pair Edits + MUE Limits

MCP NCCI Claims Validation

A Model Context Protocol (MCP) server for validating CPT/HCPCS code pairs against CMS NCCI (National Correct Coding Initiative) edits. Checks Procedure-to-Procedure (PTP) bundling edits and Medically Unlikely Edits (MUE) to prevent claim denials.

Why this exists

Every medical billing company needs NCCI edit validation. Billing wrong code pairs together results in automatic claim denials, lost revenue, and compliance risk. CMS publishes NCCI edits quarterly, but the raw data is difficult to work with. This server provides instant, programmatic validation with clear guidance on modifier usage.

Tools (5 total)

Tool	Description
ncci_validate_pair	Check if two CPT/HCPCS codes can be billed together. Returns edit status, modifier requirements, and rationale.
ncci_validate_claim	Validate a full claim — checks all code pair combinations for PTP edits and MUE violations.
ncci_edits	Get all NCCI PTP edits for a specific code — every code it bundles with and modifier indicators.
ncci_mue	Get the MUE limit for a code — maximum units per line/day/encounter.
ncci_search	Search edits by code, procedure name, or category.

Data

• PTP edits covering common CPT/HCPCS code pairs across 20+ specialties
• MUE entries with practitioner and facility limits
• Categories: allergy, cardiology, dermatology, E&M, GI, GYN, imaging, infusion, lab, OB, ophthalmology, ortho, pain management, PT, pulmonary, psychiatry, sleep, surgery, urology, wound repair
• Data updates available via npm run build-data

Install

npx @easysolutions906/ncci-api

Claude Desktop

Add to your claude_desktop_config.json:

{
  "mcpServers": {
    "ncci": {
      "command": "npx",
      "args": ["-y", "@easysolutions906/ncci-api"]
    }
  }
}

Cursor

Add to .cursor/mcp.json:

{
  "mcpServers": {
    "ncci": {
      "command": "npx",
      "args": ["-y", "@easysolutions906/ncci-api"]
    }
  }
}

REST API

Set PORT env var to run as an HTTP server:

PORT=3000 ADMIN_SECRET=your_secret node src/index.js

Method	Endpoint	Description
POST	/validate	Validate a code pair
POST	/validate/claim	Validate a full claim
POST	/validate/batch	Batch validate multiple claims
GET	/edits?code=99213	Get all edits for a code
GET	/mue?code=99213	Get MUE limit for a code
GET	/search?q=arthroscopy	Search edits by keyword
GET	/stats	Edit counts by category
GET	/data-info	Data freshness and record counts
POST	/checkout	Create Stripe checkout session

Examples

Validate a code pair:

curl -X POST https://your-server.com/validate \
  -H 'Content-Type: application/json' \
  -d '{"code1": "99213", "code2": "36415"}'

{
  "code1": "99213",
  "code2": "36415",
  "canBillTogether": false,
  "hasEdit": true,
  "comprehensiveCode": "36415",
  "componentCode": "99213",
  "modifierIndicator": 1,
  "modifierIndicatorDescription": "Modifier allowed — use modifier 25, 59, XE, XS, XP, or XU to unbundle",
  "message": "NCCI edit: 36415 bundles 99213. Apply modifier 25/59/XE/XS/XP/XU to 99213 if services are distinct."
}

Validate a full claim:

curl -X POST https://your-server.com/validate/claim \
  -H 'Content-Type: application/json' \
  -d '{"codes": ["99213", "36415", "80053"], "modifiers": {"99213": "25"}}'

Get MUE limit:

curl https://your-server.com/mue?code=97110

{
  "code": "97110",
  "found": true,
  "description": "Therapeutic exercises, 15 min",
  "practitionerMue": 4,
  "rationale": "Up to 4 units (60 min) therapeutic exercise per day",
  "adjudicationIndicator": 2,
  "adjudicationDescription": "Per Day Edit — applies per beneficiary per day"
}

Pricing

Plan	Validations/day	Batch	Rate	Price
Free	20	5	5/min	$0
Starter	500	25	30/min	$29.99/mo
Pro	5,000	50	100/min	$99.99/mo
Business	50,000	100	500/min	$299.99/mo

NCCI Edit Types

PTP (Procedure-to-Procedure) Edits

Code pairs that cannot be billed together unless a modifier is applied. Each edit has a modifier indicator:

• 0 = Not allowed — no modifier will unbundle
• 1 = Modifier allowed — use 25, 59, XE, XS, XP, or XU
• 9 = Not applicable

MUE (Medically Unlikely Edits)

Maximum units for a code per line/day/encounter. Adjudication indicators:

• 1 = Claim Line Edit
• 2 = Per Day Edit
• 3 = Per Encounter Edit

Audit Trail

Every response includes dataVersion (CMS quarter), buildDate, and validatedAt (ISO timestamp) for compliance documentation.

Transport

• stdio (default) — for local use with Claude Desktop and Cursor
• HTTP — set PORT env var for Streamable HTTP mode on /mcp

Disclaimer

This tool is provided for informational and screening purposes only. It does not constitute medical or billing advice. Always verify against the current CMS NCCI edit files. Compliance decisions remain the responsibility of the user.