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A new CPT code approved for an AI radiology assessment tool - but a long road to potential payor reimbursement

The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel recently approved a new Category III CPT code for an artificial intelligence (AI) technique in radiology. In an excellent feature article, the respected online publication, Auntminnie.com, explores the ramifications of the new code, and the possibility that the AI service is now on a path toward someday being reimbursed by Medicare and third-party payors.

The new Category III code -- 0691T -- describes the use of AI for the "automated analysis of an existing computed tomography study for vertebral fracture(s), including assessment of bone density when performed, data preparation, interpretation, and the report [of that assessment]." The new code was incorporated into the list of CPT codes on the AMA website on July 1, and is effective on January 1, 2022.

Category III CPT codes are temporary codes designed for emerging technologies, services, and procedures. These codes facilitate the collection of data to create documentation for U.S. Food and Drug Administration (FDA) product clearance and to validate the general clinical application.

Auntminnie interviewed a number of well-regarded experts, including my friend Dr. Eliot Siegel of the University of Maryland and the Baltimore VA Medical Center. Dr. Siegel correctly noted that adoption of the new code doesn't equate to Medicare or private payor reimbursement. It represents, as he says," the promising very early steps toward more routine reimbursement of AI algorithms by the U.S. Centers for Medicare and Medicaid Services (CMS) and other payors." But he cautions that it will be a "very slow process requiring a good deal of collection of compelling data and patience by the diagnostic imaging community."

The new code represents a positive development at the infancy of potential reimbursement for the use of AI technology. It will be a slow but fascinating process to watch. Be patient.

[Note to reader. There is no paywall to read this article, but one does need to register to access the Auntminnie.com website.]

"More importantly, radiological specialty societies led the code proposal, ensuring that radiologists -- the physician experts in imaging appropriateness, acquisition, and interpretation -- remain a part of the payment models for AI."

Tags

health care & life sciences, diagnostic radiology, ai, cpt, payment

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