The Protecting Access to Medicare Act of 2014 (PAMA) requires an appropriate use criteria (AUC) consult to be performed via a Centers for Medicare and Medicaid Services (CMS) qualified clinical decision support mechanism (qCDSM) when ordering advanced diagnostic imaging for Medicare patients. Under the current law, without a documented CDS consult, rendering providers will not receive Medicare payment for the procedure once the penalty phase begins.
The 2024 Medicare Physician Fee Schedule final rule, released November 2023, finalized a proposal to pause the PAMA AUC program due to continued concerns with the real-time claims processing aspect of the statute. The program, including the ongoing educational and operations testing period, will pause, effective January 1, 2024; however, CMS continues to recognize the value of the AUC program and encourages providers to continue to use clinical decision support. ACR staff prepared a brief summary of the CMS decision, including a brief history of the program’s regulations.
It is important to note that the PAMA AUC law has not been repealed. The ACR will continue to work with CMS to solve the logistical issues preventing full implementation of this important quality program that will ensure Medicare patients receive the right imaging at the right time. The resources below can help you and your referring providers prepare to comply with the AUC mandate.
Direct questions about the AUC program to PAMA-AUC@acr.org.