Many times, clients inquire how their practices can increase reimbursement by performing new procedures or by
utilizing additional existing CPT codes. As everyone knows, AI in radiology is making progress in specific
applications. Over the coming years many of these new AI applications will present opportunities for radiology
practices to increase reimbursement. One of the most advanced applications is a diagnostic ultrasound AI
application represented by two 2022 Category III codes. Category III codes are temporary codes for emerging
technologies used to track adoption and are the first step in the process of issuing a permanent category I CPT
code with Medicare Physician Fee Schedule reimbursement.

Beginning in 2022, the American Medical Association (AMA) issued the two new Category III codes for ultrasound
artificial intelligence (AI) software below. They can be used together with or separately from existing ultrasound
examination codes. The AMA had heard the plea of ARRS, ACR, RSNA, and AUR, and the specialty’s first Category
III CPT codes for AI were issued. The Category III codes are:

• 0689T—Quantitative ultrasound tissue characterization (nonelastographic), including interpretation and
report, obtained without diagnostic ultrasound examination of the same anatomy (e.g., organ, gland,
tissue, target structure)

• 0690T—Quantitative ultrasound tissue characterization (nonelastographic), including interpretation and
report, obtained with diagnostic ultrasound examination of the same anatomy (e.g., organ, gland, tissue,
target structure) (List separately in addition to code for primary procedure)

These new codes might come as a surprise to some readers, but they are a direct result of the major radiology
societies work with the AMA CPT Editorial Panel, suggesting that future AI codes will follow this path.

Some ADVOCATE clients have already begun to utilize the Koios’ DS Breast and Thyroid Ultrasound AI software
represented by the new 2022 Category III codes and are receiving reimbursement from some payors. These AI
applications could be a source of new reimbursement for your practice currently. In the future they will likely be
eligible for full reimbursement by Medicare, Medicaid and private payors. Other AI applications will surely offer
similar opportunities to increase revenue in the future.

Before you adopt any AI functionality, check with your payors for guidance and their current reimbursement
policy. The radiology AI situation is dynamic and evolving rapidly. As always, ADVOCATE will keep you up to date
on this and all issues impacting medical groups as they become available.

 

Kirk Reinitz, CPA

President and Chief Development Officer