January 28, 2019

CMS Releases Appropriate Use Criteria Fact Sheet for Referring Providers

The Centers for Medicare and Medicaid Services (CMS) has released an Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging fact sheet.

Published on the Medicare Learning Network, the fact sheet helps referring providers prepare to meet the Jan. 1, 2020 federal mandate that they consult AUC through a qualified Clinical Decision Support Mechanism (CDSM), when ordering advanced medical imaging for Medicare beneficiaries, and provide consultation information to furnishing professionals and facilities. 

Furnishing providers must then report AUC consultation information on their Medicare claims. The mandate applies to Medicare imaging performed in the physician office, independent diagnostic testing facility, hospital outpatient (including emergency department) and ambulatory surgery center settings.

While 2020 will be an “education and operations testing period” where claims will not be denied for incorrect reporting of AUC information, CMS is clear that the AUC consultation is mandatory.

Beginning January 1, 2021, Medicare claims for imaging services (both technical component and professional component) will be denied if AUC consultation information is not correctly reported on the claim.

The ACR urges members to download the new CMS fact sheet and share it with your referring providers.

The College also urges you to take part in the R-SCAN program – along with your referring providers – to prepare for mandatory CDS use.

The ACR and the Radiology Business Management Association (RBMA) will co-host a webinar on Feb. 20 at 7pm ET to help you prepare for the coming AUC mandate as well.

For more information about the AUC mandate, visit ACR.org/CDS.

For questions, please contact Kathryn Keysor, ACR senior director of economics and health policy at kkeysor@acr.org.