August 12, 2020 CMS announced an extension the education and operations testing period for the Appropriate Use Criteria (AUC) program for advanced diagnostic imaging through 2021. AUC is expected to impact all providers who order advanced diagnostic imaging (computed tomography (CT), positron emission tomography (PET), nuclear medicine, and magnetic resonance imaging (MRI)) with limited exceptions.
The Protected Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the appropriateness of advanced diagnostic imaging services provided to Medicare patients. To validate whether the advanced imaging is appropriate, a provider would need to consult a qualified Clinical Decision Support Mechanism (CDSM) at the time the imaging is ordered. CDSM are electronic portals that determines if AUC has been met. For more information, review MLN Fact Sheet “Appropriate Use Criteria for Advanced Diagnostic Imaging” ICN 909377 December 2018
The voluntary education and operations testing period, was slated to close at the end of the year. Payment penalties were scheduled to go into effect January 1, 2021. The extension would delay payment penalties until January 1, 2022. This was a godsend delay, considering the changes relating to COVID-19, the 2021 E&M office guidelines and ICD-10-CM/PCS annual changes.