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Priority Clinical Areas

Section 414.94(b) defines priority clinical areas as clinical conditions, diseases or symptom complexes and associated advanced diagnostic imaging services identified by CMS through annual rulemaking and in consultation with stakeholders.

CMS finalized an initial list of priority clinical areas in the CY 2017 Physician Fee Schedule Final Rule.

Section 414.94(e)(5) establishes the following priority clinical areas:
  • Coronary artery disease (suspected or diagnosed)
  • Suspected pulmonary embolism
  • Headache (traumatic and nontraumatic)
  • Hip pain
  • Low back pain
  • Shoulder pain (to include suspected rotator cuff injury)
  • Cancer of the lung (primary or metastatic, suspected or diagnosed)
  • Cervical or neck pain

In the CY 2017 Physician Fee Schedule Proposed Rule, CMS proposed to set forth the initial list of priority clinical areas. The following table was made available and was intended to provide stakeholders with diagnosis codes that were used to describe the proposed priority clinical areas: Proposed_Priority_Clinical_Area_Appendix2.