A request goes in. Then, sometimes, nothing happens.
On April 27, 2026, Rep. Neal Dunn (R-FL) introduced H.R. 8500, the Timely Access to Coverage Decisions Act of 2026 — sponsors' materials refer to it as the Ensuring Timely Access to Coverage Decisions Act — with Reps. Nanette Barragán (D-CA) and Claudia Tenney (R-NY) as cosponsors. The bill has been referred to the House Ways and Means and Energy and Commerce Committees.
"Americans on Medicare too often face unnecessary delays and red tape in seeking coverage determinations for needed care," Dunn said when introducing the bill. Barragán framed the same problem from the beneficiary side: "Too often, seniors and people with disabilities face long delays or inconsistencies in Medicare covering innovative medical devices or treatments," she said that could otherwise improve quality of life.
Radiology is among the specialties supporting the bill, alongside other specialty and patient-advocacy groups, according to Radiology Business. That's a distinct reimbursement lever from the ones already reshaping radiology budgets this year — prior-authorization reform, site-neutral payment cuts, and the add-on payments covered in xAID's look at AI access disparities. This one is about how long CMS itself takes to decide whether something is covered at all.
NCDs already have a clock. LCDs don't — that's the point of this bill.
Medicare coverage runs on two parallel tracks. A national coverage determination (NCD) is made by CMS itself and applies everywhere; a local coverage determination (LCD) is made independently by one of the regional Medicare Administrative Contractors (MACs) that process claims for a given multi-state jurisdiction, and can differ from one jurisdiction to the next.
CMS's own regulations already put a clock on the national track: up to 6 months to analyze a complete NCD request that doesn't need an external technology assessment or advisory-panel review, or 9 months for one that does, followed by a 30-day public comment period and up to 60 more days to finalize — roughly 9 or 12 months, start to finish, per the CMS coverage determination process. A GAO audit published in September 2025 found CMS actually hit that clock on 83% of national coverage determinations (44 of 53) decided between October 2012 and February 2025 — but the other nine ran over by an extra 6 to 351 days, and auditors found CMS had no systematic way of tracking why those delays happened. GAO's fix: identify the causes of delay (CMS says that's now done) and publicly disclose how it prioritizes which requests to work first (still open as of January 2026).
The local track has no equivalent clock at all. A physician group, device maker, or professional society can ask a MAC for an LCD, and — absent the kind of deadline H.R. 8500 would create — there is no statutory point by which an answer is guaranteed. That gap is exactly what the bill is written to close, and it's a separate problem from how much Medicare pays once something is covered.
What H.R. 8500 would actually change
| Step in the LCD process | Today | Under H.R. 8500 |
|---|---|---|
| Completeness review of a new or reconsideration request | No statutory deadline | 60 days, with written notice of anything missing |
| Final decision on a complete request | No statutory deadline | 1 year |
| Draft determination & public meeting | Varies by MAC — not consistently offered | Mandatory; meeting within 60 days of the draft, with remote-participation option |
| Public comment period | Varies by MAC | At least 30 days, with required written responses |
| Escalating a MAC's decision | No formal path | Physicians, societies, developers, and beneficiaries can request CMS review |
| Effective date of a final LCD | Set at MAC discretion | At least 45 days after posting |
All of it phases in one year after enactment, per the bill text — so even a smooth path through Congress this session wouldn't change how a request filed today is handled.
Why radiology specifically is at the table
Radiology's interest in LCD reform predates this bill. The American College of Radiology led a coalition of 20 medical organizations in a March 19, 2026 meeting with CMS — the first such meeting since June 2024 — to raise exactly the inconsistency H.R. 8500 targets: provider-engagement meetings piloted at some MACs (Noridian, and more recently NGS) aren't offered consistently across all MAC jurisdictions, and clinical input doesn't reliably shape LCDs before they're finalized. The timing lines up with CMS's own FY2025–2028 CCSQ Strategic Roadmap, released March 11, 2026, which lists modernizing both the NCD and LCD processes as one of five agency priorities.
There's a live example of what's at stake. In early 2026, MAC National Government Services proposed an LCD denying coverage for automated brain-MRI detection and quantification technologies (CPT codes 0865T and 0866T) across 10 northeastern and midwestern states, while a separate MAC, Celerian Group, had already implemented non-coverage for Ohio and Kentucky. Same technology category, same national Medicare program, two different regional answers — with no fixed date by which providers in the other jurisdictions would know where they'd land.
What this means for anyone budgeting for AI-reporting technology
Imaging centers and teleradiology groups evaluating AI vendors aren't just weighing accuracy and workflow fit — they're weighing when a purchase will pay for itself, and reimbursement timing is part of that math. Many AI-enabled imaging tools carry their own CPT or HCPCS codes, and whether a given MAC covers that code, on what terms, and by when is exactly the kind of question the LCD process answers — or, today, doesn't answer on any fixed schedule. A capital or staffing decision that depends on a coverage ruling that "may sit for a long time with no clear endpoint" is a decision made partly on faith.
That's a different exposure than the one xAID covered in its look at NTAP reimbursement gaps, where a technology is already covered but paid unevenly. Here, the technology may not have a clear coverage answer at all in a given MAC jurisdiction, for an unknown length of time. Buyers evaluating AI vendors right now have reason to ask two concrete questions: does this technology require its own new coverage determination, or does it bill through codes Medicare already covers as part of the standard interpretation and reporting workflow — and if it's the former, has the vendor tracked how that specific MAC jurisdiction has ruled.
Where xAID fits
AI CT reporting built on foundation models is designed to sit inside the reporting workflow radiologists and referrers already bill under, rather than introduce a new device category that first needs its own NCD or LCD — which keeps a purchase decision independent of how quickly a given MAC jurisdiction moves. The other side of that same accountability question is who signs the report: xAID's in-house radiologist reviews every preliminary, and it arrives ready-to-sign, with the reading radiologist's signature the final step before it reaches a patient's chart.
Frequently asked questions
What is a Medicare national coverage determination (NCD)?
A national coverage determination is a nationwide decision CMS makes directly about whether and how Medicare pays for a specific item, service, or technology. By regulation, CMS has up to 6 months to decide requests that don't need an external technology assessment or advisory-committee review, or up to 9 months for ones that do — followed by a 30-day public comment period and up to 60 more days to issue a final decision, for a total of roughly 9 or 12 months.
How is a local coverage determination (LCD) different from an NCD?
LCDs are coverage decisions made by regional Medicare Administrative Contractors (MACs) rather than CMS itself, and they can vary from one MAC jurisdiction to the next. Unlike NCDs, LCDs currently carry no statutory deadline — a request from a physician group, device maker, or professional society can sit with a MAC indefinitely. H.R. 8500 is written specifically to close that gap.
What does H.R. 8500, the Timely Access to Coverage Decisions Act, actually require?
Introduced April 27, 2026 by Rep. Neal Dunn (R-FL) with Reps. Nanette Barragán (D-CA) and Claudia Tenney (R-NY), the bill would require MACs to determine within 60 days whether a new or reconsideration LCD request is complete, and to issue a final decision within one year. It also mandates published draft determinations with supporting evidence, public meetings, comment periods of at least 30 days, and a new process letting physicians, professional societies, device or test developers, and beneficiaries ask CMS to review a MAC's decision.
Why does the pace of Medicare coverage decisions matter to buyers evaluating AI-reporting technology?
Many AI-enabled imaging tools bill under codes that individual MACs decide whether to cover, jurisdiction by jurisdiction, through the LCD process — and a MAC can propose non-coverage with no fixed clock on when a final answer arrives. That uncertainty makes it hard for imaging centers and teleradiology groups to budget for and time technology purchases around Medicare reimbursement. AI-reporting tools that plug into existing, already-covered CPT reporting codes rather than requiring a new device-specific coverage decision carry less of this particular timing risk.
Source: Radiology Business; bill text and status via Congress.gov, H.R. 8500; sponsor statements via Rep. Dunn's office and Rep. Barragán's office; NCD timelines and audit findings via CMS and the GAO (GAO-25-107623, Sept. 2025); ACR coalition meeting and CCSQ roadmap via ACR and CMS; brain-MRI AI non-coverage proposal via ACR. Figures are rounded as reported.