Appropriate Use Criteria Program

Section 218(b) of the Protecting Access to Medicare Act of 2014 amended Title XVIII of the Social Security Act to add section 1834(q) directing CMS to establish a program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging services. In section 1834(q)(1)(B) of the Act, AUC are defined as criteria that are evidence-based (to the extent feasible) and assist professionals who order and furnish applicable imaging services to make the most appropriate treatment decisions for a specific clinical condition.
This program was introduced in the CY 2016 Physician Fee Schedule (PFS) Final Rule with Comment Period available at https://www.gpo.gov/fdsys/pkg/FR-2015-11-16/pdf/2015-28005.pdf (pages 71102-71116 and pages 71380-71382).
Questions regarding this program may be submitted to the CMS Imaging AUC resource box:ImagingAUC@cms.hhs.gov

Medicare Claims Data Methodology and Background

2014 Medicare Claims Data for Selected Advanced Imaging Services

Data set [non compliant Excel file]
Data set [508 compliant HTML file]

Proposed Priority Clinical Areas and Diagnosis Codes - CY2017 PFS Proposed Rule

Proposed_Priority_Clinical_Area_Appendix2

Qualified Provider Led Entities (PLEs) as of June 2016
American College of Cardiology Foundation
American College of Radiology
Brigham and Women's Physicians Organization
CDI Quality Institute
Intermountain Healthcare
Massachusetts General Hospital, Department of Radiology
National Comprehensive Cancer Network
Society for Nuclear Medicine and Molecular Imaging
University of California Medical Campuses
University of Washington Physicians
Weill Cornell Medicine Physicians Organization

Information Collections Under 42 CFR 414.94
OMB Control Number: 0938-1288
Expiration Date: 6/30/2019