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A radiologist reads a non-contrast CT in the ED.
The AI already flagged the chest and abdomen for multiple emergent conditions before the read even started. 🩺
This week, that workflow got a price tag from CMS.
According to the American College of Radiology, CMS approved a New Technology Add-on Payment, or NTAP, for BriefCase-Triage: CARE Multi-Triage CT Body, Aidoc’s AI tool that analyzes CT images and flags potentially urgent findings. The maximum add-on payment is $137.53 per case in FY 2027. It goes live October 1.
The consensus view: this is a win for AI adoption. Reimbursement unlocks deployment. Full stop.
My read is different.
This is a win, and a warning shot, at the same time.
Here is what the headlines are skipping:
💡 CMS also finalized a policy to eliminate the alternative NTAP pathway beginning with FY 2028 applications.
That alternative pathway was the route for FDA Breakthrough Device designees to reach NTAP faster. It is gone. Starting FY 2028, every technology seeking add-on payments must demonstrate substantial clinical improvement and meet the same eligibility standards. No shortcuts.
So the window that made it easier to get paid just closed behind Aidoc.
The numbers worth understanding:
– The FY2027 IPPS final rule projects a 2.3% payment update for qualifying hospitals
– Overall hospital payments projected to increase by $2.1 billion in FY 2027
– Additional payments for new medical technologies expected to increase by about $779 million
– Max NTAP for this AI tool: $137.53 per case
📋 Three questions every radiology AI leader should be asking right now:
1. Does your AI tool meet the substantial clinical improvement standard, with evidence, not just an FDA clearance letter?
2. Do your costs exceed the standard DRG payment threshold that triggers NTAP eligibility?
3. If you were planning to use Breakthrough Device designation as your NTAP shortcut, what is your FY 2028 strategy?
Save this list. You will need it when your health system finance team asks why they should pay for your AI subscription.
The implication for anyone deploying imaging AI today: reimbursement is now a clinical evidence game, not a regulatory timing game. CMS is paying for what works and closing the lane that rewarded what was merely novel.
At Oatmeal Health, we think about this constantly. Lung cancer screening AI has to clear a different bar, detection performance and population reach, but the underlying logic is the same. The payer will eventually ask: show me the improvement, not just the clearance.
The era of AI reimbursement is here. So is the era of AI accountability.
Those are the same era.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
