Medicare Approves Reimbursement for Aidoc's Inpatient Radiology AI System

The Centers for Medicare and Medicaid Services has approved a new technology add-on payment for Aidoc's Clinical AI Reasoning Engine, known as CARE Multi-Triage CT Body, setting a maximum reimbursement of $137.53 per inpatient case. The decision marks one of the first times a federal payer has established a dedicated payment pathway for an AI-driven radiology triage product used in hospital inpatient settings.

What Happened

CMS approved the new technology add-on payment, or NTAP, for Aidoc's CARE Multi-Triage CT Body system. The NTAP designation allows hospitals to receive supplemental Medicare reimbursement on top of standard diagnosis-related group payments when the qualifying technology is used during an inpatient stay. The approved maximum rate is $137.53 per case.

NTAP status is granted by CMS to technologies that meet three criteria: they must be new, they must offer a substantial clinical improvement over existing treatments or diagnostics, and the standard DRG payment must be inadequate to cover the cost of the technology. CMS reviews NTAP applications annually as part of its inpatient prospective payment system rulemaking cycle.

About Aidoc and the CARE Platform

Aidoc is a medical AI company whose software is designed to analyze medical imaging and flag findings for clinical review. The company's CARE platform, described as a Clinical AI Reasoning Engine, is built to perform multi-condition triage across CT body imaging. The system is intended to help radiologists and clinical teams prioritize cases based on detected findings, covering a range of conditions identified from CT scans of the body.

Aidoc's products are currently deployed across a network of hospitals and health systems in the United States. The company has previously received FDA clearance for multiple AI-based imaging analysis tools covering different anatomical regions and clinical indications.

How the Payment Works

Under the NTAP structure, hospitals that use CARE Multi-Triage CT Body during a covered Medicare inpatient admission can receive the supplemental payment in addition to the standard DRG reimbursement for that case. The $137.53 figure represents the maximum allowable add-on amount. Actual payments may vary depending on case costs and how the NTAP calculation applies to individual claims.

The NTAP designation is time-limited. CMS policy generally allows new technology add-on payments for a period of two to three years, after which the technology is expected to be adequately reflected in standard DRG rates as it becomes more widely adopted and cost data matures.

Context Within the Radiology AI Market

Federal reimbursement has been a persistent challenge for AI companies operating in the radiology sector. While FDA clearance establishes the legal basis for marketing an AI imaging product in the United States, it does not guarantee that hospitals or payers will be compensated for using it. The absence of clear reimbursement pathways has been cited by hospital administrators and AI developers as a barrier to broader clinical adoption.

The NTAP approval for Aidoc's system follows a broader pattern of CMS beginning to engage with AI-assisted clinical tools through existing payment mechanisms. CMS has also addressed AI in outpatient and physician fee schedule contexts, though inpatient coverage approvals of this kind remain relatively uncommon for software-based diagnostic tools.

Other radiology AI companies have pursued similar reimbursement strategies, with varying outcomes. The Aidoc decision adds a concrete payment benchmark to the inpatient segment of that market.

What Comes Next

The NTAP payment is expected to take effect for applicable inpatient cases in the federal fiscal year covered by the current CMS inpatient prospective payment system final rule, with hospitals required to report use of the qualifying technology on Medicare claims to receive the supplemental reimbursement.