Patient advocacy groups urge Congress to create pathway for CMS to cover AI in radiology

More than a dozen patient advocacy groups on Monday urged Congress to help create a pathway for the Centers for Medicare & Medicaid Services to cover AI in radiology and other specialties.

The organizations made their case in a letter to leaders of the congressional bodies tasked with overseeing appropriations in the Senate and House. As of Monday, the U.S. FDA has approved or cleared 882 AI- or machine learning-enabled medical devices, the vast majority of which are in radiology.

However, CMS has only assigned payment for about 10 of these AI applications, limiting access for those who can’t afford the cash-pay amount, Right Scan Right Time and others contend.

“We cannot afford to exacerbate existing healthcare disparities by restricting access to cutting-edge AI-enabled medical devices only to those who can pay out of pocket,” the groups wrote to Rep. Kay Granger and Sen. Patty Murray, both chairwomen in the House and Senate appropriations committees, respectively, on May 13. “However, Medicare can help to address this issue and recognize the value AI brings to patient care by appropriately reimbursing physicians who use FDA cleared or approved AI tools.”

Patient groups want Congress to “formalize a payment pathway” for AI devices in the 2025 Hospital Outpatient Prospective Payment Systems rule. Those signing the letter included Patients Rising, ZERO Prostate Cancer and Practicing Physicians of America, among others. Imaging lobbying group AdvaMed also promoted the letter this week.

“As part of Patients Rising’s mission to put patients in control of their healthcare decisions, we call on Congress to take action and ensure that all patients have access to these innovative tools, which promote early intervention and positive health outcomes,” CEO Terry Wilcox said in a statement.

Marty Stempniak

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. 

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