Clinical Decision Support


Starting January 1, 2018, the Protecting Access to Medicare Act (PAMA) will require referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (CT, MR, nuclear medicine exams and PET) for Medicare patients. 

Providers can access imaging AUC via stand-alone electronic clinical decision support (CDS) systems or CDS software embedded in a physician’s electronic health record (EHR). The ACR anticipates providers documenting that they consulted AUC by entering a provider identifier likely to be called a “decision support number (DSN)” in the exam order. 

The ACR-developed CDS — 
ACR Select® (digital ACR Appropriateness Criteria®) — can be integrated into most common EHRs. ACR Select is expected to meet PAMA requirements. CMS will announce approved CDS systems by June 30. 

No rendering provider — radiologist or otherwise — may receive Medicare payment for an advanced imaging exam if the referring provider does not verify that imaging AUC were consulted. Ordering physicians cannot shift the requirement to consult the guidelines to radiologists. Imaging providers cannot perform AUC administrative duties for referring providers. 

Imaging providers may refuse Medicare referrals lacking the DSN and not be competitively disadvantaged. 

Exams performed in the emergency department are included in the PAMA rule — except for the most emergent of cases. Inpatient exams are also exempted. HHS may make limited exceptions for rural providers with limited internet connectivity.

What You Need to Know

Watch Videos

Clinical Videos

Iowa Radiological Society at AMCLC 2013 Video 1

Delivering Value-Based Radiology

ACR Select Webinar

What You Need to Do

By promoting CDS/AUC use, radiologists can position themselves as a resource to hospital/health system administrators as medicine transitions from volume- to value-based care.
  1. Use ACR Select®
    Educate referring providers on ACR Select (digital ACR Appropriateness Criteria®), which meets PAMA requirements. ACR Select may be integrated with all major computerized ordering/EHR systems and is freely available to all providers via the ACR Select web portal
  2. Participate in R-SCAN™
    Take part in the Radiology Support, Communication and Alignment Network with your referring providers to get familiar with CDS/AUC. By participating in R-SCAN, you also get CME Credit and ABR MOC Part 4 Credit. R-SCAN is CMS-funded and is administered by ACR.

Journal Articles

ACR Select

ACR Select is the digitally consumable version of the ACR Appropriateness Criteria®, ready to incorporate into EHR systems to guide providers ordering medical imaging.

Get ACR Select

Radiology Support Communication and Alignment Network

Collaborate with radiologists and referring clinicians to improve imaging appropriateness based on Choosing Wisely topics.

Participate in R-SCAN