Medicare contractor proposes denying coverage for AI-based brain MRI technology
A Medicare Administrative Contractor is proposing to deny coverage for key artificial intelligence-powered technology used to assess MRIs of the brain.
Indianapolis-based National Government Services issued the official local coverage determination on Jan. 22 and is accepting comment on the matter through March 8. Its ruling pertains to Medicare payment for automated detection and quantification of brain scans, covered by temporary CPT payment codes 0865T and 0866T.
If finalized, the decision would impact radiology providers across Illinois, Minnesota, Wisconsin, Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. The technologies in question can help radiologists when tracking changes in MR images over time for patients with neurodegenerative diseases such as Alzheimer’s.
The Medicare contractor contends that datasets used to train these AI models “lack sufficient diversity to account for variations related to age, gender or ethnicity.” This limitation is “particularly relevant” among the Medicare population, “where age-related changes in brain volume are common.”
“Without standardized data, it is difficult to determine whether subtle changes reflect true pathology or normal variation,” National Government Services said in its ruling, adding it will continue monitoring evolving research on this topic. “At this time, there is insufficient evidence of clinical utility or validity, and use of this technology is considered investigational and therefore not covered.”
Products impacted by the proposed ruling would include NeuroQuant from Cortechs.ai, Icobrain and Icobrain Aria from Icometrix (recently acquired by GE HealthCare), DeepBrain from Vuno Inc., and Siemens Morphometry Analysis. Belgium-based Icometrix says on its website that it originally submitted the two CPT codes in question prior to their approval by the American Medical Association, with them taking effect Jan. 1, 2024. It estimates that over 30 U.S. insurers have processed claims using the two codes.
The American College of Radiology highlighted the coverage determination in a news update published Wednesday. ACR previously partnered with Icometrix last year, providing its AI MRI quantification software to imaging facilities participating in the Alzheimer’s Network for Treatment and Diagnostics, or ALZ-NET. Icobrain Aria helps radiologists to track the impact over time from new Alzheimer’s treatments Leqembi and Kisunla.
ACR reports that Celerian Group Company Administrators, the Medicare Administrative Contractor serving Ohio and Kentucky, also stopped covering these AI services on Jan. 19, with more info available here. National Government Services, meanwhile, plans to host a public meeting on Feb. 26 to discuss its draft ruling and hear presentations from imaging stakeholders. Those interested can submit a written request by Feb. 12.
“ACR encourages members, particularly neuroradiologists who use these emerging AI enabled MRI tools to review the proposals and consider submitting comments,” the college said.
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.