Artificial or augmented intelligence (AI) is reshaping how care is delivered. Yet translating AI-enabled clinical tools from pilot projects into standard practice is one of the most complex challenges in healthcare innovation. Four essential enablers inform clinical adoption of AI-enabled services and help patients to benefit from promising technologies:
- Foundational definitions and classification standards
- Physician adoption at the point of care
- Evidence generation and performance analysis
- Pathways to payment
Establishing foundational definitions & classification standards
Current Procedural Terminology (CPT®) codes give AI-enabled services a recognized clinical identity. The uniform language provided by CPT codes supports the goals of improving interoperability and reducing administrative friction. With the precision needed to distinguish advanced clinical services, CPT codes enable reimbursement and physician payment pathways.
Category III CPT codes are temporary codes designed for emerging technology, such as AI-enabled services. They allow for data collection on clinical efficacy, utilization and outcomes before those services can meet the high standard of clinical evidence required for Category I CPT codes.
CPT Appendix S is the AI taxonomy for medical services and procedures developed by the CPT Editorial Panel. It defines and classifies AI-enabled clinical services as assistive, augmentative or autonomous technologies, allowing them to be understood, tracked and validated. The CPT Editorial Panel recently updated the Appendix, to be effective Jan. 1, 2027, to sharpen the distinction between assistive and augmentative services, and to define what counts as a clinically meaningful output.
Fostering physician adoption at the point of care
CPT codes are embedded in the clinical and administrative infrastructure that physicians, health systems and payers already use. When a clinical AI service is described by a CPT code, it can move through existing electronic health record (EHR) systems, claims workflows and payer contracts without requiring new integration at every care site. That standardization is what lowers the barrier to adoption at the point of care, allowing physicians to incorporate AI-enabled services into practice using the systems and processes already familiar to them.
Supporting evidence generation & performance analysis
When clinical AI services are reported under CPT codes, the resulting claims create a structured, longitudinal dataset that can be analyzed across payers, health systems and geographies. Without standardized coding, cross-site utilization and outcome analysis is fragmented and limited. Category III CPT codes are specifically designed to enable this kind of data collection, allowing utilization, clinical context and outcomes to accumulate over time before a service can meet the higher evidentiary threshold required for Category I status. That claims-based evidence base is what payers and the CPT Editorial Panel rely on when evaluating whether a service is ready for broader recognition and adoption.
Enabling pathways to payment
For payers and the Centers for Medicare & Medicaid Services (CMS) to recognize a clinical AI service for reimbursement, they first need a standardized way to identify what service was performed. CPT codes provide that identifier in the outpatient and physician services context, including through programs designed to support emerging innovations, like CMS’s New Technology Ambulatory Payment Classifications.
Evolving with medicine
The AMA is committed to ensuring AI in healthcare is safe, effective and trusted by physicians and patients. As digital medicine and AI continue to evolve, the AMA and CPT Editorial Panel continue to evolve the CPT code set, convening clinical and market perspectives in critical areas related to physicians’ and other qualified healthcare professionals’ adoption of digital medicine, and inviting participation from stakeholders across the healthcare ecosystem.
Apply for a CPT code
If you’re developing AI-enabled clinical tools, coding can be a fundamental consideration within the innovation lifecycle. Explore criteria for CPT codes, CPT Appendix S, and CPT code change application instructions and guidance. Submit your application online via the CPT Smart App and have it reviewed through the CPT Editorial Panel process.
Disclaimer: This information does not supersede specific coding guidance published in the CPT codebook, which is subject to change and further modification by the CPT Editorial Panel. Establishment of a CPT code does not imply approval, endorsement, or sponsorship of the medical procedure or service by the AMA. A CPT code does not guarantee coverage, reimbursement, or payment. The AMA disclaims responsibility for any errors or omissions and for any consequences attributable to or related to any use, reliance, or interpretation of the information herein.
