August 11, 2020

CMS Extends Educational and Operations Testing Period for Appropriate Use Criteria Consultation

On Monday, Aug. 10, the Centers for Medicare and Medicaid Services (CMS) announced that the Educational and Operations Testing Period for the appropriate use criteria (AUC)/clinical decision support (CDS) mandate for all advanced diagnostic imaging services will be extended through Dec. 31, 2021. This decision provides additional time for practices to implement clinical decision support systems (CDSMs).

During the Educational and Operations Testing Period, CMS expects ordering professionals to begin consulting qualified CDSMs and providing information to the furnishing practitioners and providers for reporting on their claims. Situations in which furnishing practitioners and providers do not receive AUC-related information from the ordering professional can be reported by modifier MH. Even though claims will not be denied during this educational and operations testing period, inclusion is encouraged.

CMS did not address the AUC mandate for advanced diagnostic imaging services in the Medicare Physician Fee Schedule proposed rule released last week, instead choosing to announce the delay on its website. This means that the decision is final and not subject to comment.

In addition to the announcement on the timing of the mandate, CMS also updated the list of qualified clinical decision support mechanisms available for referring providers to use.

For questions about the AUC mandate, please email