American College of Radiology asks CMS to create new alternative payment pathway for high-value AI
The American College of Radiology is urging Medicare to create a new alternative payment pathway for high-value AI technologies.
ACR’s comments come in response to the 2025 Hospital Inpatient Prospective Payment System rule released in April. The college wants the Centers for Medicare & Medicaid Services to consider revising the New Technology Add-on Payment (or NTAP) rules to establish this framework.
CEO William T. Thorwarth Jr., MD, noted that there may be some overlap with the existing pathway for “certain transformative new devices.” However, he believes criteria for an AI-dedicated alternative could focus on “clinical value and stakeholder engagement.”
Currently, U.S. Food and Drug Administration staffers primarily determine which products earn the agency’s “breakthrough” designation. But the program was not intended to inform CMS payment policy decisions, ACR noted.
“FDA is not required to consider a product’s value to the Medicare patient population as part of a Breakthrough Device designation,” Thorwarth wrote to CMS on June 6. “Moreover, due to the internal, nonpublic setting of these designations, physician experts and other stakeholders do not have prior knowledge or input into which specific products are included by FDA staff in that program.”
ACR is suggesting that the new AI payment pathway could help to select products based on their “newness” (enabling a clinically valuable task not previously achievable), “uniqueness” (addressing a high-value clinical case not previously targeted) and “value” (based on physician input and performance data). CMS also could require the ongoing collection of data on AI technology, the college urged.
“This activity would enable evaluations in the ability of the AI technology to perform requested transactions over time and, potentially, to better understand the value of the technology to clinical end-users and Medicare patients,” Thorwarth wrote. “Lessons learned from performance data collection could inform long-term payment decisions after the technology is no longer eligible for NTAP,” he added.
The college also is urging CMS to require participating manufacturers to collaborate with radiologists and other relevant specialists to help optimize performance and clinical value. As part of this, the agency could consider sponsoring a public event with the FDA and relevant radiology stakeholders to inform future requirements of any AI-specific NTAP alternative pathway.
You can read ACR’s full letter here and a news update about the IPPS posted on June 12 here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.