Appropriate Use Criteria
The Appropriate Use Criteria program was established to ensure that advanced diagnostic imaging services provided to Medicare patients are being validated through clinical decision support mechanisms (CDSMs) before the order for testing is placed.
The CDSMs are electronic portals that providers use to review clinical information as well as obtain information for reporting on their claims. Imaging studies that are required to have this review include:
- Computed Tomography (CT)
- Positron Emission Tomography (PET)
- Nuclear Medicine
- Magnetic Resonance Imaging (MRI)
The educational and operations testing period runs from January 1, 2000, through December 31, 2022. The AUC program is scheduled to be fully implemented on January 1, 2023. The program was originally scheduled to be implemented on January 1, 2022, but due to the ongoing COVID-19 pandemic, the date was changed to January 1, 2023, or January 1 following the end of the COVID-19 Public Health Emergency.
Here is a link to the CMS page discussing the program: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program