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Medicare just created payment codes for AI. Everything changes now.
We’ve been waiting for this moment since ChatGPT launched.
CMS announced new CPT codes for AI-augmented care, and it’s bigger than most realize. Starting this year, providers can bill for:
• Diabetic retinopathy AI screening
• Coronary plaque AI assessment
• AI-assisted ECG analysis
• AI-enhanced echocardiograms
• AI-guided ultrasounds
But here’s what’s revolutionary:
These aren’t just add-on codes. They’re establishing AI as legitimate clinical infrastructure, not experimental tech.
💡 The real impact?
Smaller practices can finally justify AI investments. When you can bill for AI-enhanced diagnostics, the ROI calculation completely changes. That $50K AI platform suddenly makes financial sense.
CMS is also testing codes for inpatient deterioration prediction and triage optimization. Imagine getting reimbursed for AI that prevents readmissions or catches sepsis early.
The timing is perfect. NVIDIA just announced their new Vera Rubin chip will cut AI inference costs by 10x this year. Combine cheaper hardware with billable AI services, and we’re looking at widespread adoption by year end.
But here’s my concern:
Will these codes create a two-tier system? Practices with AI capabilities billing higher rates while safety net providers fall further behind?
FQHCs serving 30 million patients need these tools most, yet they’re least likely to afford the upfront costs, even with reimbursement promises.
The solution? CMS should create enhanced payment rates for AI adoption in underserved areas, similar to meaningful use incentives. Otherwise, health equity gaps will widen, not narrow.
This isn’t just about technology adoption anymore. It’s about who gets access to AI-enhanced care and who doesn’t.
The payment codes are here. The technology works. Now we need to ensure everyone benefits, not just those who can afford the entry fee.
♻️ Repost if AI in healthcare needs equitable payment models
👉 Follow me, Jonathan Govette, for daily, real-time updates on healthcare technology and business news. LinkedIn Profile: https://www.linkedin.com/in/jonathangovette/
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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/
