The Centers for Medicare & Medicaid Services has officially assigned a national payment rate to the artificial intelligence-based prostate cancer mapping tool.
Healthcare company Avenda Health made the announcement on Thursday, saying the payment allocation applies to its Unfold AI tool. The American Medical Association has also implemented Category III codes for reimbursements related to the use of the product.
Code 0898T allows providers to bill for the use of prostate cancer estimate maps generated by this tool. These maps are generated from image-guided fusion biopsy and advanced analysis of pathology and include tumor margin visualization, margin determination, and physician interpretation and reporting.
Medicare reimbursement rates are determined by the Hospital Outpatient Prepaid Payment System (OPPS), while reimbursement for physician services by private insurers varies by individual contract.
“Unfold AI receiving new CPT codes and national payment rates is an important development in bringing advanced personalized prostate cancer care to more patients,” Dr. Brit Berry-Pusey, chief operating officer at Avenda Health, said in the release. “This recognition by the AMA and CMS validates the transformative potential of our technology to improve diagnostic accuracy and patient outcomes.”
The agreement officially came into effect on July 1st.
