July 31, 2019: CMS released guidance
related to the Appropriate Use Criteria (AUC) program that will begin Jan. 1, 2020 with a one year educational and operations testing period. The Protecting Access to Medicare Act of 2014 established the AUC program in an effort to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries that include computed tomography, positron emission tomography, nuclear medicine, and magnetic resonance imaging.
Ordering professionals will be required to consult a qualified Clinical Decision Support Mechanism to provide a determination of whether the order adheres to AUC, or if the AUC consulted was not applicable (e.g., no AUC is available to address the patient’s clinical condition). Rendering professionals will include the AUC consultation code on their Medicare claims. CMS will begin rejecting claims that do not contain the AUC consultation code starting Jan. 1, 2021.