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Tackling the Economics of Artificial Intelligence

An understanding of the alphabet soup of current and future payment models will be needed -- and it must begin with the current fee-for-service (FFS) model. In this system, specific medical services, procedures, and supplies are reimbursed using the CMS Healthcare Common Procedure Coding System (HCPCS)1. Level I of the HCPCS system is based on Current Procedural TerminologyTM (CPT), which is a numeric coding system developed and maintained by the American Medical Association.The CPT system identifies and describes medical services and procedures commonly furnished and billed by physicians and other healthcare professionals. However, CPT does not include the codes needed to separately report medical items or services for patients that are provided outside of the physician office setting (e.g., durable medical equipment and supplies). The Level II HCPCS was established to provide codes for non-physician providers to submit claims for these items to Medicare and private health insurance programs.