Early Adoption of Autonomous Artificial Intelligence Screening for Diabetic Retinopathy After Introduction of...

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.

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.

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.

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.