Who Will Pay for AI?

Chen, Melissa M; Golding, Lauren Parks; Nicola, Gregory N · Radiol Artif Intell · 2021

other · Level V

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Abstract

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. <b>Keywords:</b> Computer Applications-General (Informatics), Technology Assessment © RSNA, 2021.