Header: More MACs Block Medicare Coverage of Advanced Imaging in Radiology.
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I've often mentioned that experts interested in the growth of AI in pathology should look to advances in AI in radiology for signposts. See for example a 2022 blog on the topic here. (Also here). This may be even more important now, as AMA is advancing ideas originally thought up in the context of radiology, to apply to both radiology and pathology, which alarms me. 2026 blog here.
The CGS MAC brought out and finalizing, and the NGS MAC has just proposed, an LCD that doesn't pay for any kind of advancd diagnostic algorithms in MRI. Amazingly, the CGS MAC LCD got ZERO comments.
The LCDs are titled, "Automated Detection and Quantification of Brain MRIs."
- The CGS MAC LCD DL40224 was proposed with comment period in October.
- Now it's proposed newly for the NGS MAC region - as DL40332. Comment to March 8, 2026.
The gist of it is,
The use of AI augmented technology does not eliminate the need for appropriate reader training, and the results are not intended to be used independently of physician interpretation. National Government Services does not consider automated detection and quantification of brain MRI imaging to be reasonable and necessary.Investigations have explored the potential of automated quantification technology for the evaluation of ARIA, MS, TBI, epilepsy, brain tumors, and other neurologic conditions. However, progress has been limited by the lack of established measurement standards and insufficient access to large, diverse datasets for training these tools....Without standardized data, it is difficult to determine whether subtle changes reflect true pathology or normal variation. At this time, there is insufficient evidence of clinical utility or validity, and use of this technology is considered investigational and therefore not covered. National Government Services will continue to monitor the evolving research related to these devices.
