Appropriate use criteria (AUC) program for advanced diagnostic imaging services
As announced in the CY 2024 Physician Fee Schedule (PPS), effective January 1, 2024, CMS is pausing efforts to implement the AUC program for reevaluation and rescinding the AUC regulations at 42 CFR 414.94, reserving this section for future use. CMS has not specified a timeframe within which implementation efforts will recommence.
Effective January 1, 2024, providers and suppliers should no longer include AUC consultation information on Medicare FFS claims. However, claims containing AUC related codes with dates of service in 2023 and 2024 will continue to process. Codes include G1000 through G1024 and modifiers MA through MH and QQ.
CMS plans to end the above described HCPCS G codes and modifiers, effective December 31, 2024, to assist in claims processing and data analysis.
Background
The Protecting Access to Medicare Act (PAMA), established the AUC program to increase the rate of appropriate advanced diagnostic imaging services furnished to Medicare beneficiaries. Examples of advanced imaging includes:
- Computed tomography.
- Magnetic resonance imaging.
- Nuclear medicine.
- Positron emission tomography.
Since 2015, CMS has worked to implement the statutory requirements in notice and comment rulemaking and the Program has operated in the educational and operations testing period on January 1, 2020, during which there were no payment penalties.
CMS created a number of HCPCS G codes to identify Clinical Decision Support Mechanisms and modifiers to help implement the AUC Program. These G codes include G1000 ─ G1024 and modifiers include MA ─ MH and QQ.
The AUC Program, as authorized in PAMA, required practitioners that order advanced diagnostic imaging services to consult AUC using an electronic Clinical Decision Support Mechanism (CDSM) tool when ordering these imaging services. Practitioners that provide the imaging services reported the AUC consultation information obtained by the ordering practitioner on the claims for the imaging services.
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