Economics.
This page covers the three financial questions that come up most often: what lung nodule characterization reimburses under CPT 0721T and 0722T, what a lung nodule program costs to run and what it returns, and what an earlier stage at diagnosis is worth to a health system.
RevealAI-Lung is the first medical imaging AI software to achieve reimbursement within the European Union, and is reimbursed within the United States.
CPT is a registered trademark of the American Medical Association. Code descriptions are summaries; confirm against the current CPT code set and your payer’s policy. CPT codes are for product usage within the United States.
The two reimbursement codes.
Both describe quantitative CT tissue characterization, including interpretation and report. The difference is whether a new CT is performed in the same session.
| Code | When it applies | In practice |
|---|---|---|
| 0721T | Characterization on a previously acquired CT, with no concurrent CT examination. Reported on its own. | A lung nodule is found on a CT that was read without characterization. The study is pulled back and the lung nodule analyzed retrospectively, with no new scan ordered. |
| 0722T | Characterization performed with a concurrent CT examination. An add-on, reported in addition to the primary CT code. | The lung nodule is found and characterized during the read of a newly acquired CT. |
Billed once per patient per encounter, regardless of how many nodules are characterized. Both are carrier-priced Category III codes, so there is no national Medicare rate — each MAC sets payment, and it varies by locality. Reimbursement information above applies to product usage within the United States.
For radiology.
Your place of service determines which components your group bills.
| Setting | What is billed | What comes to the group |
|---|---|---|
| POS 11 — freestanding imaging center, non-facility | Global rate | Technical and professional components together, plus the professional fee for interpretation |
| POS 22 — hospital outpatient, hospital-owned equipment | Professional component | The interpretation. The technical component goes to the facility under OPPS. |
The gap between global and professional-only is substantial in every jurisdiction we have confirmed. Tell us your MAC and locality and we will look up the published rate for both codes and show you the figure. Reimbursement information above applies to product usage within the United States.
Easy to implement, even for small billing groups.
One code per patient per encounter. The structured report is generated automatically and serves as the billing documentation. Appeal templates and peer-reviewed citations are provided for denials.
0721T reaches scans already read.
A lung nodule found on a CT that was read without characterization can be analyzed afterwards and billed under 0721T, with no new scan ordered.
For lung nodule programs.
Nodule programs are usually funded as overhead — navigator salaries, tracking systems, coordinator time — against a benefit that is real but hard to attribute. mSI gives the program a revenue line of its own: a billable service on every characterized lung nodule, so the volume the program handles funds the coordination around it.
| What mSI™ adds | How it works |
|---|---|
| A billable service | Characterization is reimbursable under 0721T and 0722T, billed once per patient per encounter regardless of how many nodules are characterized. |
| Coordinator hours | The scarcest resource in most programs. A reported value lets the queue be worked in an order that reflects something other than date and size. |
| Fewer patients worked up who did not need it | A low mSI™ is recorded in the report, giving the team an objective basis for keeping a patient in routine surveillance rather than escalating out of caution. |
| Fewer patients lost | In one series of 696 incidental nodules, naming the nodule in the impression cut non-concordant follow-up by 45%. Patients who fall out of the pathway cost more later. |
| Quality assurance | Every characterized nodule carries the same objective measure, so the program can be reviewed on consistent data — follow-up concordance, time to workup, and where patients drop out. |
For hospital systems.
At system level, reimbursement is just the start of benefits. What matters is stage at diagnosis, and the impact on patients who undergo unnecessary procedures.
Late-stage disease costs more to treat, for longer.
In SEER-Medicare data covering almost 146,000 lung cancer patients, surgery cost around $30,100 as a single episode, while chemotherapy and radiation ran between $4,242 and $8,287 per month through the first six months of care. In the continuing phase, patients treated surgically cost about $1,100 a month against $4,809 for those on chemotherapy.
Invasive workup of benign nodules carries cost and harm.
Biopsy complication rates reported in the literature run between 15% and 28%, including pneumothorax and hemorrhage. Every benign nodule taken to biopsy consumes procedural capacity and exposes a patient to that risk for no diagnostic gain.
Better nodule classification means fewer unnecessary procedures
In the ORACLE study of a risk biomarker in benign nodules, tested patients were 74% less likely to undergo an invasive procedure than matched controls — roughly one procedure avoided for every seven patients tested. Different technology, same principle: better stratification reduces procedures on nodules that never needed them.
Patients diagnosed at later cancer stage pay more for therapy.
Among commercially insured patients, cumulative out-of-pocket costs reached $35,243 by three years after a stage IV lung cancer diagnosis, and were consistently higher for later-stage than earlier-stage disease.
Read these as context, not as our results. The figures above describe what stage at diagnosis and unnecessary procedures cost in the published literature. They are not outcome data for RevealAI-Lung, and we make no claim that particular savings follow from using it.
Sources.
| Claim | Source |
|---|---|
| Lung cancer treatment cost by phase and strategy | Sheehan DF et al. Lung cancer costs by treatment strategy and phase of care among patients enrolled in Medicare. Cancer Medicine, 2019 (SEER-Medicare, 145,988 patients; 2017 US dollars) |
| Out-of-pocket cost by stage at diagnosis | Out-of-pocket cost by cancer stage at diagnosis in commercially insured patients in the United States. Journal of Medical Economics, 2023 |
| Biopsy complication rates | Zhao Y et al. Diagnostic network meta-analysis of AI imaging and liquid biopsy for pulmonary nodule characterization. International Journal of Surgery, 2026 |
| Reduction in invasive procedures with better stratification | ORACLE study: assessing a biomarker’s ability to reduce invasive procedures in patients with benign lung nodules, 2023 (NCT03766958) |
| Follow-up concordance and the report impression | Pannu J et al. CHEST Pulmonary, 2025 |
| RevealAI-Lung reader performance | FDA clearance K251769; Adams SJ et al. Journal of the American College of Radiology, 2023; Duerden L et al. Clinical Radiology, 2026 |
Get the reimbursement guide.
Everything your billing and compliance teams need to implement these codes, in one document.
- Coding and billing guide for 0721T and 0722T
- Place of service guidance — POS 11 and POS 22
- Documentation requirements and a report addendum template
- Letter of medical necessity
- Prior authorization checklist
- Denial appeal letter template
Diagnostic indications.
Link each claim to a diagnosis that reflects the finding. Commonly used codes:
| ICD-10-CM | Description | Use |
|---|---|---|
| R91.1 | Solitary pulmonary nodule | A single incidentally detected lung nodule |
| R91.8 | Other nonspecific abnormal finding of lung field | Multiple nodules, or a finding not described as solitary |
Secondary codes describing relevant risk factors may support medical necessity. Code selection is the responsibility of the billing provider; confirm against current ICD-10-CM guidance and your payer’s coverage policy.
In the United States, RevealAI-Lung is indicated for incidentally-detected lung nodules 6–15 mm in patients 18 and over. It is not indicated for lung cancer screening.
Frequently asked questions.
What is the difference between 0721T and 0722T?
0721T is used when the characterization is performed on a CT acquired previously, with no new CT in the same session. 0722T is an add-on used when a new CT is performed and characterized in the same session.
Do Category III codes get paid?
Category III codes are tracking codes for emerging technology. Payment depends on the payer. For Medicare these codes are carrier-priced, meaning each MAC determines payment. Commercial coverage varies and may require prior authorization.
Can we bill once per nodule?
No. The codes are reported once per patient per encounter, however many nodules are characterized.
What documentation supports the claim?
The mSI value in the medical record, a signed interpretation by the radiologist, and a statement of medical necessity explaining how the result informed management. Our billing guide includes templates for each.
What if a claim is denied as investigational?
Appeals typically cite the peer-reviewed evidence, include the full quantitative report, and note that the AMA has assigned a CPT code; an appeal letter template is in the billing guide.
Does POS 11 billing apply to us?
If your group owns or bills for its own CT equipment and bills in the non-facility setting, yes. If you read on hospital-owned equipment, you bill the professional component only.
Questions about your own payers?
0721T and 0722T are carrier-priced, so rates vary by MAC, locality and place of service. Contact us for the rates that apply in your jurisdiction.