Early Adoption of Autonomous Artificial Intelligence Screening for Diabetic Retinopathy After Introduction of Medicare Billing Code 92229.

Abstract

Purpose: Diabetic retinopathy remains a leading cause of blindness in the United States. Autonomous artificial intelligence (AI) systems for screening have received US Food and Drug Administration authorization, and a dedicated Medicare billing code for autonomous point-of-care retinal screening was introduced in 2021. This study aimed to characterize observed utilization, billing National Provider Identifier (NPI) uptake, provider-type distribution, and geographic spread of autonomous AI screening in Medicare from 2021 to 2023.

Methods: This study performed a retrospective descriptive analysis of the 2021-2023 Medicare Physician & Other Practitioners-by Provider and Service public-use files. Current Procedural Terminology (CPT) 92229 was the primary focus, with CPT 92227 and 92228 included as contextual comparators.

Results: Autonomous AI screening increased nearly tenfold, from 143 services in 2021 to 1,427 in 2023. Unique billing NPIs increased from 5 to 39. Optometry accounted for 57.7% of services, followed by family practice (13.9%), endocrinology (12.5%), and internal medicine (11.9%). The number of states with observed use increased from 3 to 16, and urban providers accounted for 96.6% of observed services. In 2023, observed use corresponded to approximately 15.3 services per 100,000 Medicare beneficiaries identified as having diabetes using fee-for-service claims. Estimated Medicare payments captured in the file increased from $3,538 to $42,889.

Conclusion: Autonomous AI screening showed rapid early growth in Medicare Part B after introduction of code 92229, with expansion across billing NPIs, provider types, and states. Absolute use nonetheless remained small, indicating early billing uptake rather than meaningful population penetration.