The American College of Radiology recently met with congressional advisors to discuss reimbursement for imaging AI.
ACR provided the Medicare Payment Advisory Commission with details about the current regulatory landscape for such software. The college said it emphasized that “thoughtful assessment” will be needed to address where AI belongs on the Medicare payment schedule.
“We are pleased by the positive reception from MedPAC during our discussion in which we highlighted opportunities and precautions for reimbursement for this promising technology,” Greg Nicola, MD, chair of the ACR Commission on Economics, said in a March 6 news update.
Medicare has covered algorithm-driven software for assisting providers in making assessments since 2018. About 10 software-as-a-service codes are recognized by both the Hospital Outpatient Prospective Payment System and Medicare Physician Fee Schedule, ACR reported last year. However, most such codes have low utilization volumes, with varying levels of reimbursement based on the payment system.
Commissioners stressed the importance of striking the correct balance, with software that produces measurable clinical benefits, remains affordable for beneficiaries, and receives the appropriate reimbursement. Members of MedPAC also have advocated for AI software payment as part of a bundle, rather than standalone reimbursement, to help keep incentives tied to clinical care rather than monetary goals, ACR noted.
“This is a newer topic of discussion for MedPAC, so additional dialogue is expected,” the college said in its update.
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.