RadNet confident payers will cover its breast imaging AI solution by 2026
Imaging center operator RadNet Inc. is confident some commercial payers will cover its breast imaging artificial intelligence solution by the year’s end.
Leaders with the publicly traded, Los Angeles-based organization discussed the possibility during RadNet’s first quarter earnings call on Monday. The Enhanced Breast Cancer Detection (EBCD) program first launched in 2023, with it today charging patients an extra $40 to have AI read over their mammograms, providing an added layer of protection.
About 40% of women are opting for the AI add-on, which increases their likelihood of cancer being detected by 21%, according to research presented at RSNA 2024. Leaders said at the time they’re hopeful commercial payers will eventually pony up so patients don’t have to pay out of pocket, and they’re now forecasting this could occur soon.
“Payers have begun to take notice, and based upon constructive conversations with them, we are confident that one or more national carriers, other insurers, and self-insured employers will offer reimbursement for the EBCD program as early as year-end,” President and CEO Howard Berger, MD, read from prepared remarks on May 12. “This reimbursement event and others like it could mark the expansion of a new era where radiology becomes more utilized in population health screening programs.”
Berger and colleagues estimated RadNet collected roughly $4 million from EBCD in the first three months of 2025. This represented a 33% uptick from the $3 million tallied during the same period in 2024. RadNet in February also inked its first deal to have a third-party provider outside of its company using the AI program.
OB/GYN Specialists of the Palm Beaches, Florida, will launch breast imaging services across multiple locations, using RadNet's contracted radiologists to read the images. The 60-year-old, 10-location obstetric and gynecological care provider also will use AI to improve its patients’ cancer assessments. As of Monday, over 50% of OB/GYN Specialists’ patients are adopting EBCD as part of their mammography screening, Berger told investors. RadNet sees opportunity for further growth in EBCD, with it spreading the technology to iCAD customers later this year after finalizing its $103 million acquisition of the vendor.
During the call’s question-and-answer portion, investors asked whether RadNet believes Medicare will eventually cover the EBCD technology, too. Berger said he believes this may occur in the opposite order as when the federal payment program for seniors started covering 3D mammography.
At the time, there was “very early” adoption of the technology by Medicare, which prompted commercial payers “begrudgingly” to also do so, Berger recalled. He noted that, to date, the feds have only covered a select few AI tools in clinical areas such as cardiac and thyroid imaging.
“I believe it is going to be a difficult lift,” Berger said. “We’re having very positive conversations with commercial, other types of payers, and self-insurers, who see the value. I believe they will adopt it. And we have, I think, been very instrumental in establishing a price point, which is comfortable for our patients, and probably will translate into something that sets a standard for the industry. But I believe it will come from the non-governmental side this time, as opposed to in the past.”