MEDPAC is a longstanding official body that advises Congress on Medicare policy issues. At their Nov 2, 2023, virtual meeting, they will discuss Medicare and "Software as a Service" (330-445 ET).
>> Register for video access:
https://www.medpac.gov/meeting/november-2-3-2023/
The short agenda is described as,
11/02/2023 . 3:30 pm - 4:45 pm ET:
- Medicare coverage of and payment for software as a medical service: An overview
- ISSUE: Software is becoming increasingly important and pervasive in healthcare.
- KEY POINTS: Medicare covers and pays for certain types of medical software that receive approval or clearance by the Food and Drug Administration. The software that we discuss in this session generally stands apart from hardware (i.e., software that is used for one or more medical purposes to diagnose or treat an illness or injury without being part of the medical service).
- ACTION: Commissioners will provide feedback on the material presented.
Medicare wrestes this topic, reluctant to pay for licensing fees or per click fees, and generally viewing software as "built in" (such as inside a PET scanner purchase) or "overhead" (aka ignore).
A Few Perspectives
- In current PFS rulemaking, under its RVU system, CMS declined to accept an AMA RUC valuation of Heartflow-type software (I believe the AMA RUC accepted an invoice-based $1500/service license fee).
- This will play out in the final CY2024 PFS rule, to be issued circia 11/01.
- Blog.
- Other examples may include a new Category III code for software (and assistance) that helps rank-order cancer therapy choices for patients who have full multi-hundred gene sequences.
- Press release.
- CureMatch, "Patient-specific, assistive, rules-based algorithm for ranking pharmaco-oncologic treatment options based on the patient’s tumor-specific cancer marker information obtained from prior molecular pathology, immunohistochemical, or other pathology results which have been previously interpreted and reported separately."
- In another area, some half-dozen PLA codes have been created that include AI or "augmented intelligence" and these have been valued anywhere from around $700 to $5400.
- Blog. Scroll down for "slide-based imaging".
- Note that, just like CMS writes NCD's only for FDA approved tests, CMS is conspicuously talking about payment for FDA-approved software.
