APPROPRIATE USE CRITERIA

Protecting Access to Medicare Act (PAMA) requires referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (ADIS) including CT, MR, Nuclear Medicine and PET. It is important to note that the law does not mandate ordering providers to strictly adhere to the AUC, just consult AUC. Unlike prior authorization, there is no “hard stop” to the ordering process. We are highlighting this requirement to ensure the implementation process goes smoothly and your patients continue to receive the best quality care

More About ACR

Clinical Decision Support Mechanisms

Appropriate Use Criteria is an alternative to CMS requiring pre-authorization for all advanced imaging — which could pave the way for other payers to eliminate this burdensome step. The result? Easy access to AUC can help keep evidence-based decision making between physicians and patients, as unlike “hard stop” prior authorization, AUC consultation allows physicians to choose the best test for patients based on their individual circumstances.

Imaging CDS technology can help identify opportunities for quality improvement initiatives and spark collaboration between radiologists and referring providers around improvements in value-based imaging.

Program Flyer

Provider Letter