Advanced Practice Providers AUC Resources

The Centers for Medicare and Medicaid Services (CMS) announced that the payment penalty phase of the appropriate use criteria (AUC) consultation mandate will not begin Jan. 1, 2023 nor the January 1 following the end of the COVID-19 public health emergency as planned. CMS states that it is “unable to forecast when the payment penalty phase will begin.”

The Protecting Access to Medicare Act (PAMA) requires referring clinicians to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (CT, MR, Nuclear Medicine and PET) for Medicare outpatients — including those performed in the emergency department (ED).

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.

Below are suggested resources and activities to help Advanced Practice Providers (including nurse practitioners and physician assistants) become familiar with the PAMA requirements.

1. Get prepared for PAMA implementation

2. Read the series Imaging Stewardship in the Age of Value published in the Journal of the American College of Radiology.

3. Become more proficient at ordering high-value imaging exams

Complete the Value-Based Imaging Activities and obtain a certificate of participation that documents participation in an activity designated for AMA PRA Category 1 Credits™.

  1. Value-based Imaging Podcasts discuss strategies for image ordering and highlight how the ACR Appropriateness Criteria® supports Choosing Wisely® recommendations.
  2. CDS Choosing Wisely Case Reviews present cases designed to test knowledge of appropriate imaging and CDS technology that delivers evidence-based AUC to guide selection of the most appropriate imaging for patients.

Access Value-Based Imaging Activities »

4. Prepare to meet PAMA requirements by participating in R-SCAN

Learn how a nurse practitioner championed improved imaging care for patients and how to access the R-SCAN resources she used: 

  • Read the case study Ordering Done Right
  • Sign up for R-SCAN to gain experience with and free access to qCDSM CareSelect and champion an R-SCAN project