Medicare AI Reimbursement Statistics: 2026 Report

Medicare AI Codes and 2026 Payment Rates

The Healthcare Industry Reviews research team gathered the 2026 hospital outpatient and physician fee schedule rates for these codes.

The codes shown are those listed in the October 2026 Addendum B, except 0879T and 0880T, which have no separate OPPS rate (status N and M). Paired codes share a row, with their two short descriptors combined. Status S means the OPPS pays the code separately, Q1 means it is packaged when billed with certain other services, and E1 means the OPPS does not cover it. APC is the ambulatory payment classification, the OPPS payment group. Carrier priced means the Medicare administrative contractor sets the fee schedule amount, since CMS has not assigned relative value units.

• 75577, a new 2026 code for quantification and characterization of coronary atherosclerotic plaque, is the only code in the set besides 75580 and 92229 with national fee schedule relative value units. Its 2026 national fee schedule amount is $1,012.05.
• 0623T through 0626T, the 2025 coronary plaque analysis codes, do not appear in the October 2026 Addendum B.
• 0691T, automated analysis of an existing CT study for vertebral fracture, has OPPS status E1 in both 2025 and 2026 and no PSPS payment rows in 2023, 2024 or 2025.
• For AI device makers, Medicare coverage is still patchy, and many codes have no clear payment path. Eleven codes sit in New Technology APCs paying a flat $650.50 or $950.50, while some codes have no payments at all. Companies are likely to keep pressing for permanent codes with set payment rates.

Medicare AI Payments by Code Family, 2023 to 2025

Totaling what Medicare paid for these codes from one year to the next shows which AI services are being billed to Medicare and how quickly that use is growing.

PSPS payments are Medicare's share of allowed charges on Part B carrier claims, which include physician offices and independent diagnostic testing facilities. HeartFlow's FFR-CT was billed under 0501T through 0504T in 2023 and under 75580 from 2024.

• Medicare Part B carrier payments for the 39 codes reached $17.88 million in 2025, up 77.1% from $10.10 million in 2024 and more than four times the $4.18 million paid in 2023.
• FFR-CT accounted for 63.6% of 2025 payments, $11.37 million. Office settings (place of service 11) received 91.5% of 2025 payments for 75580.
• Diagnostic radiologists received 46.4% of 2025 FFR-CT payments and cardiologists 36.3%.
• Payments for the brain MRI quantification codes, 0865T and 0866T, which MedPAC lists for icobrain, rose from $206,103 in 2024 to $1.81 million in 2025.
• Medicare spending on AI is growing fast from a small base. Payments for the 39 codes rose 77.1% to $17.88 million in 2025, and FFR-CT took 63.6%. If this pace holds, AI payments will keep climbing, though they remain tiny next to overall Medicare spending.

Medicare AI Claims Volume and Allowed Charges, 2025

Providers bill Medicare their own list price and Medicare allows a smaller amount, so comparing the two for the most used codes shows how much of each bill Medicare accepts.

Service counts in the PSPS are suppressed in rows with small numbers. The submitted service column below adds only the unsuppressed rows, so it is a lower bound.

• Medicare allowed $14.37 million of the $69.12 million submitted for 75580 in 2025, or 20.8%.
• Medicare pays far less than providers bill for AI services. Allowed charges were 20.8% of submitted charges for 75580 and 18.6% for 0866T. Providers planning AI investments should budget on allowed amounts, not list prices.

Change in Medicare AI Reimbursement Rates, 2025 to 2026

Medicare updates these rates every year, and the change from 2025 to 2026 tells companies and clinics whether using an AI tool on a Medicare patient now pays more or less.

• The OPPS rate for 75580 fell 13.8% to $877.34 in 2026, while its national fee schedule amount rose 5.7% to $886.79. For qualifying APM participants the 2026 fee schedule amount is $891.22 (26.55 relative value units times $33.5675).
• The OPPS rate for 4DMedical's lung ventilation codes, 0807T and 0808T, fell 29.2% to $220.60.
• 92229 pays $60.27 under the OPPS and $46.76 under the fee schedule in 2026.
• Payment rates are moving in different directions depending on setting. The OPPS rate for 75580 fell 13.8% while its fee schedule amount rose 5.7%, and lung ventilation codes fell 29.2%. Hospitals and clinics are likely to weigh these shifts when deciding where to offer AI services.

What Medicare AI Reimbursement Trends Mean for 2027 and Beyond

Medicare is paying more for AI-assisted tests each year, but almost all of that money goes to one type of heart imaging. Most other AI services earn little or nothing, which makes it hard for hospitals and clinics to justify offering them.

AI developers are pushing for permanent payment codes, which would give providers steadier rates. Rates also differ between hospital and physician settings and change each year, so where a service is offered can shift from year to year. Each new code that gets a stable rate makes it more likely that tool reaches patients.

So if your practice is weighing an AI service, check what Medicare pays for it in your care setting this year before you invest.