On December 1, 2020, about a month later than the normal schedule, CMS released final rulemaking for the Physician Fee Schedule and related policies for CY2021.
The CMS press release focused on expanded telehealth services and better payments for E&M services in primary care.
- See the press release here.
- See the Fact Sheet here.
- See the "inspection copy" or typescript rule here.
- It weighs in at over 2000 pages.
- NCD Deletion
- Pricing of per click fees for AI software
- Pricing of the iRhythm service
ROYALTIES FOR AI-BASED SERVICES (PER CLICK FEES)
An interesting code is on page 489ff (typescript), 92229, imaging of retina with remote point of care automated analysis which "uses artificial intelligence technology." An image analysis fee (e.g. a per click fee or royalty fee) was proposed as part of the business model for the technology. CMS declined to value this. They write, "While we agree that the costs of AI applications should be accounted for in payment, AI applications are not well accounted for in our practice expense methodology."
These rules are normally released by November 1, to allow 60 days for implementation both at CMS and at providers, prior to January 1.