As of Jan. 1, 2020, the Protecting Access to Medicare Act now requires referring providers to consult appropriate use criteria (AUC) via a qualified clinical decision support mechanism approved by the Centers for Medicare and Medicaid Services (CMS), prior to ordering CT, MR, nuclear medicine and PET exams for Medicare outpatients.
The first year of the program is an “educational and operations” testing period, with no Medicare penalties to rendering physicians for failure to report or incorrect reporting of AUC consultation information on claims for advanced diagnostic imaging services.
Barring any changes, rendering providers will not receive Medicare technical or professional component payment for the procedure without a correctly documented AUC consult as of Jan. 1, 2021.
The American College of Radiology® (ACR®) Clinical Decision Support Resources webpage can help you and your referring providers comply with the AUC mandate. Additionally, CMS published claims guidance documents for the educational and operations testing period.
Please contact ACR staff at PAMA-AUC@acr.org with questions about this mandate.