Reimbursement
We strive to expand market access to benefit all stakeholders, especially patients. As the first and only image-based AI tool for lung cancer diagnosis with US reimbursement, Optellum Lung Cancer Prediction AI empowers clinicians to deliver high-quality, ROI-backed care.1Â With ongoing efforts to demonstrate reduced total cost of care, we are proving our value to payers and providers alike
CMS Medicare payment assignment per use of LCP AI2
cost to payers for 1 year of life gained by patients with LCP AI3
The American Medical Association (AMA) issued two Category III Current Procedural Terminology (CPT)® codes effective July 1, 2022 that may be utilized when billing for services related to utilization of the Optellum Lung Cancer Prediction AI. Category III CPT codes are temporary codes used to describe emerging technologies, services or procedures. Submitting claims with Category III codes may require additional information be submitted to the payer to establish medical necessity, and substantiate charges and payment for the service.
Hospital Outpatient Facility Coding & Medicare Payment
When LCP AI is utilized in the hospital outpatient site of service, reimbursement is determined by the Hospital Outpatient Prospective Payment System (OPPS). Procedures are assigned to the applicable Ambulatory Payment Classification (APC) for the CPT code used to describe the service. Generally, Medicare assigns CPT codes into groups where the codes are similar in terms of clinical characteristics and resource costs. Alternatively, New Technology APCs, like that under which the Optellum® technology is reimbursed, are defined on the basis of cost. Under APCs, payment is determined by the services and procedures provided as reported by the CPT code.2
CPT codes assigned to a status indicator S are not subject to multiple procedure discounting and are paid at 100% of the current OPPS payment rate.
Physician Coding & Medicare Payment
Category III CPT codes do not have any assigned relative value units (RVUs) and therefore there is no fee schedule payment rate established for physician payment under Medicare. Payment for physician services is at the discretion of the individual Medicare contractor.
Current Procedural Terminology (CPT). Copyright © 2026 American Medical Association. CPT is a registered trademark of the American Medical Association. All rights reserved.
For additional information, please contact our team via email at reimbursement@optellum.com
