CMS Appropriate Use Criteria Program for Advanced Diagnostic Imaging Services
(updated May 2020)
by Carrie Kovar, Government Relations Consultant to SCMR
What is AUC?
The Protecting Access to Medicare Act (PAMA) of 2014 established a program to mandate the use of appropriate use criteria (AUC) for advanced diagnostic imaging provided to Medicare beneficiaries.
How will I order a CMR?
Ordering professionals will be required to consult with AUC through a clinical decision support mechanism (CDSM) prior to ordering an advanced diagnostic imaging service (CT, MR, nuclear and PET). CDSMs are the electronic tools through which a clinician consults AUC to determine the level of clinical appropriateness for a patient’s clinical scenario.
What if it is not “appropriate”?
The furnishing professional will not be paid by Medicare unless the furnishing professional documents the ordering professional consulted with AUC.
When will this start?
Full implementation begins on January 1, 2021. From this date AUC consultations with qualified CDSMs are required to occur along with reporting of the consultation.
How does COVID affect this ruling?
The American Medical Association (AMA) has requested that CMS postpone implementation in 2021. CMS has yet to give any indication that it will postpone implementation. SCMR will provide updates as developments occur.
