The Centers for Medicare & Medicaid Services (CMS) has issued a billing code modifier for providers who plan to participate in the voluntary reporting period of the agency’s appropriate use criteria (AUC) program for advanced diagnostic imaging. The voluntary reporting period will begin July 1, 2018.
In a CMS update, Medicare Administrative Contractors (MACs) were informed that Modifier QQ may be reported on the same claim line as the CPT code for advanced diagnostic imaging services to indicate an AUC consultation took place.
Medicare’s AUC program was established as part of the Protecting Access to Medicare Act of 2014 to increase the rate of appropriate advanced diagnostic imaging ordered for Medicare beneficiaries. Under this program, medical practitioners will be required to consult a qualified clinical decision support mechanism (CDSM) when they order advanced imaging services for their Medicare patients. The Clinical Decision Support Mechanism (CDSM) will inform the ordering practitioner if the order adheres to the recommendations of an AUC, if it does not follow the AUC or if no applicable AUC provides guidance. The AUC program is expected to be fully implemented on January 1, 2020.
CMS noted in the 2018 Physician Fee Schedule (PFS) final rule that the program would begin with a voluntary participation period. During this time, ordering professionals may refer to qualified CDSMs and have the option to report consultation information on Medicare claims. Beginning on July 1, the QQ modifier may be:
- Used when the furnishing professional (e.g., radiologist) is aware of the result of the ordering professional’s consultation with a CDSM for that patient
- Reported on the same claim line as the CPT code for an advanced diagnostic imaging service furnished in an applicable setting and paid for under an applicable payment system and
- Reported on both the facility and professional claim
Additionally, the 2018 Quality Payment Program final rule finalized AUC consultation as a clinical improvement activity. The AUC improvement activity will allow MIPS-eligible ordering clinicians to earn a high-weighted improvement activity by attesting that they are using AUC through a qualified CDSM for all advanced diagnostic imaging services orders.
For more information, see MLN Matters Article MM10481. Questions may be posed to Kathryn Keysor (firstname.lastname@example.org) or Christina Berry (email@example.com) in the ACR Economics and Health Policy Department.