I 
119TH CONGRESS 
1ST SESSION H. R. 6197 
To amend title XVIII of the Social Security Act to ensure appropriate 
payment of certain algorithm-based healthcare services under the Medi-
care program. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 20, 2025 
Mr. JOYCE of Pennsylvania (for himself, Mr. PETERS, Ms. VAN DUYNE, Mr. 
SCHNEIDER, Mr. OBERNOLTE, and Ms. CRAIG) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to ensure 
appropriate 
payment 
of 
certain 
algorithm-based 
healthcare services under the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Tech Invest-
ment Act’’. 
VerDate Sep 11 2014 
23:56 Nov 24, 2025
Jkt 069200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6197.IH
H6197
kjohnson on DSK7ZCZBW3PROD with $$_JOB
SEC. 2. ENSURING APPROPRIATE PAYMENT OF CERTAIN 
ALGORITHM-BASED HEALTHCARE SERVICES 
UNDER THE MEDICARE PROGRAM. 
(a) IN GENERAL.—Section 1833(t) of the Social Se-
curity Act (42 U.S.C. 1395l(t)) is amended— 
(1) in paragraph (2)(E), by inserting ‘‘and new 
technology ambulatory payment classification of al-
gorithm-based healthcare services under paragraph 
(16)(H)’’ after ‘‘(16)(G)’’; and 
(2) in paragraph (16), by adding at the end the 
following new subparagraph: 
‘‘(H) SPECIAL RULE FOR CERTAIN ALGO-
RITHM-BASED HEALTHCARE SERVICES.— 
‘‘(i) IN GENERAL.—In the case of a 
covered OPD service furnished on or after 
January 1, 2026, that is an algorithm- 
based healthcare service (as defined in 
clause (ii)) that is assigned to a new tech-
nology ambulatory payment classification 
(as described in the final rule entitled 
‘Medicare Program; Changes to the Hos-
pital Outpatient Prospective Payment Sys-
tem for Calendar Year 2002’ published by 
the Department of Health and Human 
Services on November 30, 2001 (66 Fed. 
Reg. 59897)) on or after the date of the 
VerDate Sep 11 2014 
23:56 Nov 24, 2025
Jkt 069200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6197.IH
H6197
kjohnson on DSK7ZCZBW3PROD with $$_JOB
enactment of this subparagraph or for 
which, as of such date, is currently and 
has been assigned to a new technology am-
bulatory payment classification for a pe-
riod of less than 5 years, the Secretary— 
‘‘(I) shall ensure that such serv-
ice is assigned to a new technology 
ambulatory 
payment 
classification 
based on the cost of such service as 
submitted by the manufacturer of 
such service in a form and manner 
specified by the Secretary, including 
costs for the technology based on in-
voice prices, subscription-based prices, 
clinical staff, overhead, and other 
costs associated with providing the 
service; 
‘‘(II) shall adjust the new tech-
nology ambulatory payment classifica-
tion pursuant to subclause (I) as nec-
essary; and 
‘‘(III) may not remove such serv-
ice from the new technology ambula-
tory payment classification as deter-
mined under subclauses (I) and (II) 
VerDate Sep 11 2014 
23:56 Nov 24, 2025
Jkt 069200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6197.IH
H6197
kjohnson on DSK7ZCZBW3PROD with $$_JOB
until the Secretary determines that 
adequate claims data exists to reas-
sign such service to another ambula-
tory payment classification (which in 
no case may be before such service 
has received payment under the as-
signed new technology ambulatory 
payment classification for at least 5 
years). 
‘‘(ii) ADJUSTMENT.—The Secretary 
shall adjust the application process and 
criteria for the new technology ambulatory 
payment classification to ensure that, in 
addition to currently eligible algorithm- 
based healthcare services, algorithm-based 
healthcare services that otherwise meet the 
eligibility requirements for such classifica-
tion and are distinct from but performed 
concurrently with, adjunctive to, or pro-
vided in any other modality or form as 
part of an underlying service and require 
additional resources, meet— 
‘‘(I) the eligibility requirement 
that they are distinct new procedures 
with a beginning, middle, and end; or 
VerDate Sep 11 2014 
23:56 Nov 24, 2025
Jkt 069200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6197.IH
H6197
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(II) any subsequent similar new 
technology ambulatory payment classi-
fication eligibility requirement. 
‘‘(iii) DEFINITION
OF
ALGORITHM- 
BASED HEALTHCARE SERVICE.—For pur-
poses of this subparagraph, the term ‘algo-
rithm-based healthcare service’ means a 
service delivered through a device cleared 
or approved by the Food and Drug Admin-
istration that uses artificial intelligence, 
machine learning, or other similarly de-
signed software to yield clinical outputs or 
generate clinical conclusions for use by a 
physician or practitioner in the screening, 
detection, diagnosis, or treatment of an in-
dividual’s condition or disease, or any such 
other similar service as the Secretary de-
termines appropriate in consultation with 
appropriate organizations.’’. 
(b) CODIFYING OPPS PAYMENT FOR SOFTWARE AS 
A SERVICE.—Effective for services provided on or after 
January 1, 2023, the Secretary of Health and Human 
Services shall apply the hospital outpatient prospective 
payment system payment for software as a service policy 
described in the final rule entitled, ‘‘Medicare Program: 
VerDate Sep 11 2014 
23:56 Nov 24, 2025
Jkt 069200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6197.IH
H6197
kjohnson on DSK7ZCZBW3PROD with $$_JOB