Appropriate Use Criteria Program: Timeline Update

In order to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries, the Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), was established as a new program. Examples of advanced imaging services include computed tomography (CT), positron emission tomography (PET), nuclear medicine, and magnetic resonance imaging (MRI).


Under this program, a practitioner that orders an advanced diagnostic imaging service for a Medicare beneficiary (or a clinical staff acting under the practitioner’s direction) will be required to consult a qualified Clinical Decision Support Mechanism (CDSM). CDSMs are electronic portals through which appropriate use criteria (AUC) is accessed. Medicare has delayed the program timelines required full implementation date to January 1, 2021.


Many of our Urology, Primary Care and other clinicians who order advanced diagnostic imaging services under Medicare Part B may think you need to start meeting the new Appropriate Use Criteria Program but due to the delayed implementation date, this is not yet required. However, clinicians will have the opportunity to voluntarily participate next year in 2020.


We would like to inform all of our partners that iSalus is not currently supporting any integrations with CDSMs and you must use a qualified CDSM in order to voluntarily participate. For more information, please read through the Centers for Medicare & Medicaid Services page here.