Vendor UpdateLung/Thoracic Cancer

Optellum Lung Cancer Prediction Technology Gets CMS Payment Classification

By News Release


Optellum announced that a national payment rate for Optellum's Lung Cancer Prediction technology under the New Technology Ambulatory Payment Classification was established by the Centers for Medicare & Medicaid Services (CMS). This development will facilitate the process of health insurance claims for individuals enrolled in Medicare and other health insurance programs, enabling more patients to access innovative, potentially life-saving early lung cancer diagnostic technology.

Effective July 1, 2022, hospitals that bill CMS for Optellum Lung Cancer Prediction for their Medicare patients will be eligible for reimbursement at a rate of $600-$700 under temporary CPT code 0721T to describe quantitative CT tissue characterization performed separate to a computed tomography (CT) scan. These temporary codes are assigned specifically to identify new technologies such as Optellum's AI-powered decision-support software, which is already in use in several leading hospitals in the United States.

"This is another step in Optellum's progress towards becoming the standard of care for early lung cancer diagnosis. It can be difficult for patients to access new technologies because providers and physicians are often not able to offer services that are not reimbursed," said Optellum CEO Jason Pesterfield. "This new payment assignment is an important step towards incentivizing providers to make the technology more widely available."

Optellum's Virtual Nodule Clinic integrates the clinically validated Lung Cancer Prediction (LCP) score based on imaging AI and has the potential to improve clinical care coordination and decisions, with the aim to get patients treated before the disease has metastasized, thereby crucially increasing lung cancer survival rates.

In 2021, Optellum received FDA 510(k) clearance as the first AI-assisted diagnosis application for lung cancer. This year, the company secured CE and UKCA certification, allowing the technology to be used in Europe and the UK.

Dr Reggie Munden of the Medical University of South Carolina is a supporter of Optellum's technology. He has extensive experience in the application and translation of imaging research for evaluating lung nodules and lung cancer. He has participated in over 40 clinical trials and served as the National Lung Screening Trial (NLST) site PI for the MD Anderson Cancer Center (MDACC). His current role is as Professor and Chair, Department of Radiology and Radiological Science Chief, ICCE – Radiology at Medical University of South Carolina.

He views investments in new AI-based technologies for lung cancer management as critical to the future of medicine, commenting, "CMS' decision on Optellum's technology for lung nodules is recognition of the importance of ground-breaking technology that will improve patient care outcomes. Optellum's early lung cancer diagnostic allows academic medical centers like ours to advance patient care while controlling costs."