- Avenda Health’s Unfold AI, a prostate cancer mapping technology, receives a national payment rate from CMS.
- The American Medical Association introduces a new Category III code (0898T) for Unfold AI reimbursement, effective July 1, 2024.
- The Category III code enables billing for advanced, non-invasive prostate cancer estimation maps.
- Medicare reimbursement for the technology will follow the Hospital Outpatient Prospective Payment System (OPPS).
- Reimbursement for physician services and commercial payers will vary based on individual agreements.
- Unfold AI has shown an 84% accuracy in identifying prostate cancer extent, significantly improving diagnostic performance compared to traditional methods.
Main AI News:
Avenda Health, an innovator in AI-driven healthcare solutions, has announced a significant milestone for its prostate cancer mapping technology, Unfold AI. The Centers for Medicare & Medicaid Services (CMS) has established a national payment rate for this groundbreaking technology, which aims to enhance personalized prostate cancer care. Effective July 1, 2024, the American Medical Association (AMA) has also introduced a new Category III code for the reimbursement of services utilizing Unfold AI, further expanding its accessibility to patients.
Category III codes are designed to collect data on emerging healthcare technologies and methods, paving the way for future reimbursement pathways. The newly assigned code, 0898T, allows healthcare providers to bill for the advanced, non-invasive prostate cancer estimation maps provided by Unfold AI. This technology utilizes sophisticated analysis of image-guided fusion biopsy and pathology to visualize tumor margins, determine their extent, and support physician interpretation and reporting.
Under the Hospital Outpatient Prospective Payment System (OPPS), Medicare reimbursement will be aligned with the appropriate Ambulatory Payment Classification (APC) for diagnostic tests and related services, standardizing outpatient reimbursements. Reimbursements for physician services and commercial payers will vary based on individual agreements and geographic locations, reflecting the growing recognition of AI technology’s role in improving prostate cancer diagnostics.
Brit Berry-Pusey, PhD, COO of Avenda Health, expressed enthusiasm about this development: “Receiving the new CPT code and national payment rate for Unfold AI is an important step towards making advanced personalized prostate cancer care more accessible. This acknowledgment by the AMA and CMS underscores the transformative potential of our technology in enhancing diagnostic accuracy and improving patient outcomes.“
A recent study published in The Journal of Urology by researchers at UCLA has validated Unfold AI’s effectiveness, demonstrating an 84% accuracy in identifying the extent of prostate cancer. The study found that AI-assisted diagnostics improved physician performance by 45 times compared to traditional methods, promising more precise diagnoses and targeted treatments. This advancement could potentially reduce the need for full-gland removal and its associated side effects, marking a significant leap forward in prostate cancer management.
Conclusion:
The establishment of a national payment rate and the introduction of a Category III code for Avenda Health’s Unfold AI signify a pivotal moment for AI integration in healthcare. This development not only validates the technology’s effectiveness but also facilitates broader access to advanced prostate cancer diagnostics. The market impact includes increased adoption of AI-driven solutions in cancer care, potential shifts in diagnostic standards, and a move toward personalized treatment approaches. This could lead to enhanced patient outcomes and drive further investment in AI healthcare technologies.
