Appropriate Use Criteria ("AUC")


The link below provides you with a quick summary of Appropriate Use Criteria for Advanced Diagnostic Imaging.  As the "Fact Sheet" states, beginning in January 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). Services include diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including positron emission tomography).  During calendar year 2020, the AUC program begins with one year "Educational and Operations" testing period (with no penalties on rendering physicians for incorrect reporting).


As of January 1, 2020, you must use a qualified CDSM and report AUC consultation information on the professional and facility claims for the imaging interpretive services.  Beginning in January 2021, failure to report will result in denials or penalties.  Inpatient and defined emergency services (see page 6 for exceptions and the emergency services definition link) are exempt from this requirement.


HMA will continue to work with our billing and other advisors to gain further information and update our clients on this very significant issue.

Click here to read the article.

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