Federal Policy
CMS Proposes Medicare Payment Category for Clinical Decision Support Software
CMS released proposed rules on July 2 and July 14, 2026 establishing a new Medicare payment category called Software as a Medical Service (SaMS) for software that supports clinical decision-making through algorithmic analysis. The proposals appear in the CY 2027 Hospital Outpatient Prospective Payment System and Physician Fee Schedule proposed rules. This represents CMS's first structured approach to paying separately for clinical decision support software under Medicare. Comments on the proposed rules are typically due 60 days after publication in the Federal Register.
Why it mattersWhile this is a Medicare payment policy, it could signal CMS's broader approach to coverage and reimbursement of digital health tools that Medicaid programs and managed care plans increasingly encounter in care delivery and prior authorization processes.