reimbursement-guide

reimbursement-guide is a skill for Claude Code from rdmgator12/RE-MCP-. It costs 0 tokens per session (3,370 once invoked), scanned A, original, MIT.

A Medicare payment and coding reference tool based on public data from the U.S. Centers for Medicare & Medicaid Services. It covers payment calculations and several checks related to medical coding and reimbursement.

In plain words
What is it for?
It is for estimating Medicare procedure payments, checking code-edit rules, comparing settings, reviewing severity categories, and assessing denial or medical-necessity risks.
Why use it?
It helps users answer Medicare reimbursement questions without manually combining public payment and coding data.

Skill for Claude Code

Written for Claude Code: shipped in a Claude Code plugin. Also seen: mentions Claude Code.

Part of the reimbursement-engine plugin — 1 skill, 4 commands, 1 MCP server shipped together

Good fit It is for estimating Medicare procedure payments, checking code-edit rules, comparing settings, reviewing severity categories, and assessing denial or medical-necessity risks.

Compare 6 skills from other repositories ↓
Install with agentmods
npx agentmods add skills/rdmgator12/re-mcp-/reimbursement-guide
Install

Getting it into your agent

One page per mod, every tool's command on it. A separate URL per tool would split the same page into five that compete with each other.

Any agent
npx skills add rdmgator12/RE-MCP- --skill reimbursement-guide
Clone the repo
git clone --depth 1 https://github.com/rdmgator12/RE-MCP-

Made for: Claude Code.

Or install reimbursement-engine, the plugin that ships this one along with the rest of its 1 skill, 4 commands, 1 MCP server.

Wrote this? Show the measurements

A badge with what this costs and how it scanned, read live from this page, so it follows the numbers instead of freezing them. Markdown for a README, HTML for a documentation site or a project page.

agentmods badge for reimbursement-guide

README.md
[![agentmods](https://agentmods.dev/badge/skills/rdmgator12/re-mcp-/reimbursement-guide/github.svg)](https://agentmods.dev/skills/rdmgator12/re-mcp-/reimbursement-guide)
Your own site
<a href="https://agentmods.dev/skills/rdmgator12/re-mcp-/reimbursement-guide"><img src="https://agentmods.dev/badge/skills/rdmgator12/re-mcp-/reimbursement-guide/github.svg" alt="Measured on agentmods" height="20"></a>

Or the 80×15 button, for a site that already has a row of RSS and ATOM ones. Only the verdict fits; the numbers stay here.

agentmods 80×15 button for reimbursement-guide

Your own site · 80×15
<a href="https://agentmods.dev/skills/rdmgator12/re-mcp-/reimbursement-guide"><img src="https://agentmods.dev/badge/skills/rdmgator12/re-mcp-/reimbursement-guide.svg" alt="Reviewed on agentmods" width="80" height="20"></a>
Per session 0 Skills are progressive disclosure: only the name and description are preloaded; the body loads when the skill is used.
When invoked 3,370 The whole file, excluding the scripts and references it only reads on demand.
Security scan A 0 findings. A grade says what 26 rules found in the file — not that it is safe.
Origin original No closer match found in the catalogue.
Token cost

What it costs to keep this loaded

Counted locally with the o200k_base tokenizer, which is exact for GPT models; Claude uses its own tokenizer and its counts differ. Treat this as one consistent yardstick across the catalogue rather than a bill. Prices are per million input tokens.

ModelPer sessionOnce invoked
Fable 5.1 $0.00000 $0.03370
Opus 5 $0.00000 $0.01685
Sonnet 5 $0.00000 $0.00674
Haiku 4.5 $0.00000 $0.00337

Measured 11d ago against content hash e337bdb202a4, method: parsed. Prices are Anthropic first-party input rates as of 2026-09-11, from the pricing page.

Security

Grade A, and why

reimbursement-guide scanned grade A with 0 findings against 26 rules in 11 categories — prompt injection, anti-refusal, data exfiltration, privilege escalation, supply chain, agent snooping, system-prompt leakage, SSRF and excessive agency — measured 11d ago.

A static scan of the body, not an audit. Every finding is printed with the line that produced it so you can judge whether it matters here. A mod is markdown that instructs an agent; that is exactly why what it instructs is worth reading.

Nothing flagged

None of the 26 patterns this scan looks for appear in this file: no shell pipes, no recursive deletes, no credential paths, no hidden text, no instruction-override or anti-refusal phrasing, no agent-config snooping. That is not a guarantee, it is the absence of the things that are checkable.

skills/reimbursement-guide/SKILL.md · 283 lines

How it starts

The opening of the file, as written. The whole thing — 283 lines — stays where its author put it; the contents beside it link to each section on GitHub.

ReimbursementEngine — Skill Guide

Overview

ReimbursementEngine is a Medicare reimbursement intelligence plugin with 18 tools powered by CMS public data. It provides instant payment calculations, NCCI compliance checks, DRG/CC/MCC severity analysis, CDI query generation, denial risk scoring, medical necessity crosswalks, multi-setting payment comparisons, and historical RVU trend analysis — all without AMA licensing.

What This Plugin Does NOT Do

This engine calculates Medicare fee schedule base allowed amounts using CMS public data. It does not:

  • Model commercial payer rates (Blue Cross, Aetna, UnitedHealthcare, etc.)
  • Process or submit claims to any payer
  • Determine patient cost-sharing, deductibles, or copays
  • Provide real-time eligibility or benefits verification
  • Replace professional coding or billing judgment

For commercial payer prior authorization requirements and payer-specific coverage rules, see EasyPA.ai.

Tool Selection Guide

Use this decision logic to pick the right tool for the user's question.

"What does [code] pay?" / "How much is [procedure]?"

calculate_payment — Medicare payment for any CPT/HCPCS at any locality

calculate_payment(hcpcs_code="99214", locality="Tampa", place_of_service="non_facility")

"What are the RVUs for [code]?" / "Show me the components"

rvu_lookup — Raw RVU data (work, PE, MP, global period, surgery indicators)

rvu_lookup(hcpcs_code="27447")

"What's the GPCI for [city/state]?" / "Geographic adjustment factor"

gpci_lookup — Geographic Practice Cost Indices by locality

gpci_lookup(locality="San Francisco")

"List all Medicare localities" / "What localities are in Florida?"

list_localities — All 118 Medicare localities with GPCI values

list_localities(state="FL")

"Can I bill [code] with [code]?" / "Do these codes bundle?"

check_ncci_edits — NCCI PTP edit check for any code pair

check_ncci_edits(code1="29881", code2="29877")

Read the full file on GitHub · 283 lines

Files

What ships with it

4 files beside SKILL.md in the same directory: the scripts, references and assets a skill reads on demand. Not counted in the per-session cost; read them before you install if any of them is executable.

Changes

What this file has done since we first saw it

Hashed on every crawl. A supply-chain change to an agent config is a question of when, not whether, so the history is kept rather than the latest state alone.

  1. 11d ago First seen · 283 lines · 0 tokens per session scan A e337bdb202a4

Subscribe to this mod's changes

reimbursement-guide is a skill published in the GitHub repository rdmgator12/RE-MCP- (0 stars, last pushed 8d ago), licensed MIT. It costs nothing until one of its globs matches a file; then it loads 3,370 tokens. A static security scan graded it A with 0 findings. No closer match exists in the catalogue, so it is treated as the original; first seen 2026-08-31.

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