In the calendar year 2019 Medicare Physician Fee Schedule Proposed Rule, the Centers for Medicare and Medicaid Services (CMS) recommitted to the July 1, 2020, start date for the congressionally mandated appropriate use criteria (AUC)/clinical decision support (CDS) program for all advanced diagnostic imaging services. ACR staff has prepared a detailed summary of the AUC provisions of the proposed rule.
To meet its January 1, 2020, deadline, CMS reverted to a proposal from the CY 2018 proposed rule, using a series of G-codes and modifiers for claims processing. The agency notes that it will consider future opportunities to use a unique consultation identifier (UCI) for claims processing and will continue to engage with stakeholders on this topic.
The CY 2019 proposed rule also addresses provisions covering the following key aspects of the program:
- To expand the definition of “applicable setting,” including the additional of independent diagnostic testing facilities (IDTFs)
- To clarify who may perform the required AUC consultation using a qualified clinical decision support mechanism (CDSM)
- To confirm that reporting is required across claim types and by both the furnishing professional and furnishing facility
- To define and implement changes to the policy for significant hardship exceptions for ordering professionals under the program
- To identify mechanisms for claims-based reporting, and
- To request feedback on the methodology to identify outlier ordering professionals.