Developing current procedural terminology codes that describe the work performed by machines

Abstract

The “Taxonomy of Artificial Intelligence for Medical Services and Procedures” became part of the Current Procedural Terminology (CPT®) code set effective January 1, 2022. It provides a framework for discrete and differentiable CPT codes which; are consistent with the features of the devices’ output, characterize interaction between the device and the physician or other qualified health care professional, and foster appropriate payment. Descriptors include “Assistive”, “Augmentative”, and “Autonomous”. As software increasingly augments the provision of medical services the taxonomy will foster consistent language in coding enabling patient, provider, and payer access to the benefits of innovation.

Improving Neurology Clinical Care With Natural Language Processing Tools

“…“Augmentative” technology is when the machine analyzes or quantifies data in a clinically meaningful way but still requires interpretation by a physician or other qualified health care professional. And last, any machine that interprets data and independently generates clinically meaningful conclusions without physician involvement can be considered as “autonomous.” 4…”

“…And last, any machine that interprets data and independently generates clinically meaningful conclusions without physician involvement can be considered as "autonomous." 4 To understand NLP and their functionality, it is important to understand their basic technology and terminology including machine learning, neural networks, and transformers (see eAppendix 1, links.lww.com/WNL/D179).…”

Quantitative imaging workshop XIX: Utilizing quantitative thoracic imaging to optimize population health final summary

“…Richard Frank, MD, report the new taxonomy for several distinct kinds of AI services that will be the basis for Medicare physician fee schedule's approach to AI services, including machine learning and AI analysis of the thoracic CT scan acquired for lung cancer screening. 12 Zeke Silva, MD, a radiologist, and chair of American Medical Association's Digital Medicine Payment Advisory Group, provided an explanation of the components of the resource-based relative value scale, which is used to set the relative value of different CPT© codes, and how that is relevant to emerging AI services. The discussion included the relevance of these codes for lung cancer screening, 9 and how changes in the Medicare physician fee schedule operates on a zerosum basis-increases in some fees are offset by decreases in other fees.…”

“…The purpose of this panel was to define emerging trends in payer reimbursement for AI services—and physician AI services. Richard Frank, MD, report the new taxonomy for several distinct kinds of AI services that will be the basis for Medicare physician fee schedule's approach to AI services, including machine learning and AI analysis of the thoracic CT scan acquired for lung cancer screening 12 . Zeke Silva, MD, a radiologist, and chair of American Medical Association's Digital Medicine Payment Advisory Group, provided an explanation of the components of the resource‐based relative value scale, which is used to set the relative value of different CPT© codes, and how that is relevant to emerging AI services.…”

Clinical Implementation of Autonomous Artificial Intelligence Systems for Diabetic Eye Exams: Considerations for Success

“…Furthermore, in HEDIS-MIPS (Healthcare Effectiveness Data and Information Set Merit-Based Incentive Payment System) measurement year 2020, eye exams interpreted by an AI system were determined to meet criteria to fill care gaps for value-based care ( 16 , 17 ). As of 1 January 2021, the new Current Procedural Terminology (CPT) code 92229 was established to allow for billing and reimbursement using autonomous AI technology to diagnose DED, and, as of 2023, the term “autonomous AI” was reintroduced into CPT coding ( 18 , 19 ).…”