Imaging Clinical Decision Support

Imaging Appropriate Use Criteria

WHAT: An AUC consultation must occur for advanced diagnostic imaging services that are performed in a physician’s office, a hospital outpatient department (including an emergency department), an ambulatory surgical center, an independent diagnostic testing facility (IDTF) or any other provider-led outpatient setting CMS determines appropriate.

Advanced diagnostic imaging services include: Diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including positron emission tomography)

WHY: The purpose of the AUC program is to enable you to order the most appropriate test for your patient. The Centers for Medicare & Medicaid Services (CMS) will use data collected from the program to identify outlier ordering professionals who will become subject to prior authorization.

WHEN: Beginning in 2020, if you order Medicare Part B advanced diagnostic imaging services, you must consult appropriate use criteria (AUC) through a qualified Clinical Decision Support Mechanism

(CDSM). You must also provide the information to furnishing professionals and facilities, because they must report AUC consultation information on their Medicare claims. Until January 1, 2020, participating in the AUC program is voluntary. January 1, 2022 fines will be instituted for failure to participate.