Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging Services - JE Part B
Appropriate Use Criteria (AUC) Program for Advanced Diagnostic Imaging Services
Effective January 1, 2024, CMS has paused efforts to implement the AUC program for reevaluation and rescinded the AUC regulations at 42 CFR 414.94.
Providers and suppliers should no longer include AUC consultation information on Medicare FFS claims. However, claims containing AUC related codes with dates of service in 2023 and 2024 will continue to process. Codes include G1000 through G1024 and modifiers MA through MH and QQ.
Background
The Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. Examples of such advanced imaging services include:
- computed tomography (CT)
- positron emission tomography (PET)
- nuclear medicine, and
- magnetic resonance imaging (MRI)
Under this program, at the time a practitioner orders an advanced diagnostic imaging service for a Medicare beneficiary, he/she, or clinical staff acting under his/her direction, will be required to consult a qualified Clinical Decision Support Mechanism (CDSM). CDSMs are electronic portals through which appropriate use criteria (AUC) is accessed.
In January 1, 2020, CMS directed ordering providers to begin consulting qualified clinical decision support mechanisms (CDSMs) prior to ordering advanced imaging services in applicable settings for Medicare patients and providing information to the furnishing provider for reporting on their claims.
Testing period was implemented, and claims could be submitted with AUC-related coding for advanced diagnostic imaging services furnished to Medicare beneficiaries.
