Who Will Pay for AI?

In 2020, the largest U.S. health care payer, the Centers for Medicare & Medicaid Services (CMS), established payment for artificial intelligence (AI) through two different systems in the Medicare Physician Fee Schedule (MPFS) and the Inpatient Prospective Payment System (IPPS). Within the MPFS, a new Current Procedural Terminology code was valued for an AI tool for diagnosis of diabetic retinopathy, IDx-RX. In the IPPS, Medicare established a New Technology Add-on Payment for Viz.ai software, an AI algorithm that facilitates diagnosis and treatment of large-vessel occlusion strokes. This article describes reimbursement in these two payment systems and proposes future payment pathways for AI. (C)RSNA, 2021

Automated summary

In 2020, the Centers for Medicare & Medicaid Services (CMS) in the United States established payment for artificial intelligence (AI) through two different systems – the Medicare Physician Fee Schedule (MPFS) and the Inpatient Prospective Payment System (IPPS). This included reimbursement for AI tools for diabetic retinopathy diagnosis and large-vessel occlusion stroke diagnosis and treatment. The article also proposes future payment pathways for AI technologies.