Medicare Approves $137 Payment for Aidoc's CT Triage AI Tool

Medicare will reimburse hospitals up to $137.53 per inpatient case for an artificial intelligence tool that triages computed tomography scans, marking a significant step in federal coverage for diagnostic AI.

The payment applies to Aidoc's BriefCase-Triage CARE Multi-Triage CT Body tool, which analyzes body scans to identify potentially urgent conditions including appendicitis and bowel obstructions. Hospitals can begin claiming the add-on payment starting October 1, 2027, for a three-year period.

The approval came through Medicare's "alternative" new technology add-on payment pathway, which requires FDA breakthrough device designation but not proof of substantial clinical improvement. Aidoc's tool received breakthrough designation in September 2025 and 510(k) clearance in January. The reimbursement figure represents approximately 65 percent of the technology's average cost, according to the American College of Radiology.

Why it matters

This payment decision establishes a concrete reimbursement model for AI diagnostic tools in hospital settings, addressing a major adoption barrier. Healthcare systems have faced uncertainty about whether AI investments would be financially sustainable without dedicated payment codes. The three-year payment window gives hospitals a defined period to integrate the technology and demonstrate value, while Medicare gains real-world evidence about clinical impact.

Pathway closing for future applicants

Medicare approved 22 new products through the alternative pathway and eight through the traditional route in this cycle, committing an additional $779 million for emerging medical technologies in fiscal 2027. However, the Centers for Medicare & Medicaid Services announced it is eliminating the alternative pathway for applications received for fiscal 2028 and beyond.

All future applicants will need to meet the traditional pathway's requirement: demonstrating substantial clinical improvement over existing technologies. CMS cited concerns about the limited evaluation process under alternative applications and the need to ensure reimbursed technologies are not substantially similar to existing products.

"CMS believes this requirement will better align spending and value and ultimately support providers in delivering the best, data driven care possible," the American College of Radiology noted in its summary of the final rule.

Implementation details

Hospitals will identify eligible cases using ICD-10-PCS procedure code XEZ5XKC, which specifically covers computer-aided triage and notification for imaging abnormalities in CT scans of the chest, abdomen, and pelvis.

Aidoc CEO Elad Walach said the payment pathway helps address mounting pressure on health systems to deliver faster diagnoses while managing increased imaging volumes and workforce shortages. The New York-based company's tool scans for a broad set of acute findings that require rapid clinical attention.

The inpatient payment rule also applies Medicare's stricter evidence requirements to radiology AI devices seeking reimbursement on the hospital outpatient side. Overall, Medicare finalized a 2.3 percent payment increase for inpatient care, raising hospital payments by $2.1 billion in fiscal 2027.

These details were first reported by Radiology Business.