AUC for Advanced Diagnostic Imaging - Educational and Operations Testing Period - Claims Processing Requirements - Revised

MLN Matters Number: MM11268 Revised
Related CR Release Date: December 6, 2019
Related CR Transmittal Number: R2404OTN
Related Change Request (CR) Number: 11268
Effective Date: January 1, 2020
Implementation Date: January 6, 2020

Note: CMS revised this article on December 9, 2019, due to an updated Change Request (CR). The updated CR removes codes that are not available for 2020. In addition, codes have been added to the attachment in the CR that serves to replace some of the expired codes. Removed codes include: 77058, 77059, 78205, 78206, 78270, 78271, 78272, 78320, 78607, 78647, 78710, 78805, 78806, 78807. Added codes include: 77048, 77049, 78429, 78430, 78431, 78432, 78433, 78434, 78830, 78831, 78832, 78835. The CR release date, transmittal number and link to the transmittal also changed. All other information remains the same.

CR11268 informs MACs that, effective on January 1, 2020 (the start of the AUC program Educational and Operations Testing Period), they should accept the Appropriate Use Criteria (AUC) related HCPCS modifiers on claims. Please be sure your billing staff and vendors are aware of this update. Subsequent CRs will follow at a later date that will continue AUC program implementation.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)11268.

Last Updated Dec 10, 2019