CMS to reimburse providers for use of AI prostate cancer mapping tool
The Centers for Medicare and Medicaid services has officially assigned a national payment rate to an artificial intelligence-assisted prostate cancer mapping tool.
Healthcare company Avenda Health made the announcement Thursday, noting that the payment assignment applies to the company’s Unfold AI tool. The American Medical Association also implemented a Category III code for reimbursement related to the use of the product.
The code, 0898T, will enable providers to bill for utilizing the prostate cancer estimation maps produced by the tool. These maps are derived from advanced analysis of image-guided fusion biopsy and pathology, and include tumor margin visualization, margin determination, and physician interpretation and reporting.
The Medicare reimbursement rate is determined by the Hospital Outpatient Prospective Payment System (OPPS), while reimbursement for physician services from. commercial payers will be dependent on their individual contracts.
“Receiving the new CPT code and national payment rate for Unfold AI is an important development in making advanced personalized prostate cancer care accessible to more patients,” Avenda Health COO Brit Berry-Pusey, PhD, said in a release. “This recognition by the AMA and CMS validates the transformative potential of our technology in improving diagnostic accuracy and patient outcomes.”
The code officially went into effect on July 1.
The future of AI reimbursement in medicine
Unfold AI's new code joins dozens of others intended to reimburse physicians for their utilization of AI assistance. Although such payments are not yet the norm, experts believe that reimbursement will begin to gain steam as more organizations turn to AI to help address some of healthcare’s biggest pain points, such as staffing shortages.
During the SIIM 2024 conference in June, many physicians shared that their institutions are already utilizing AI in some capacity, even without being reimbursed for doing so. The general consensus among providers at the conference was that payments will come at some point, and that the current absence of reimbursement should not deter stakeholders from exploring how AI can improve their practices.
“Some CPT codes have been created, but AI as a whole is going to have to be like PACS was for radiology for a while,” Joseph Cavallo, MD, MBA, an assistant professor of radiology and biomedical imaging at the Yale School of Medicine, said during a panel discussion. “Improving workflow and efficiency for radiologists now will result in ROI and gains in the future.”
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.