Provider Led Entities

NOTICE: The EDUCATIONAL AND OPERATIONS TESTING PERIOD for the AUC Program has been extended beyond CY 2021. There are no payment consequences associated with the AUC program during the Educational and Operations Testing Period. We encourage stakeholders to use this period to learn, test and prepare for the AUC program. The payment penalty phase will begin on the later of January 1, 2023 or the January 1 that follows the declared end of the public health emergency (PHE) for COVID-19. For more information please review the CY 2022 Physician Fee Schedule Final Rule: (pages 65224 - 65241)


A Provider-led entity (PLE) is a national professional medical specialty society or other organization that is comprised primarily of providers or practitioners who, either within the organization or outside of the organization, predominantly provide direct patient care. Once a PLE is qualified, the appropriate use criteria (AUC) developed, modified or endorsed by the entity are considered specified applicable AUC.

PLEs Seeking Qualification

  • Applications must document current adherence to the evidence-based processes described in 42 CFR 414.94(c)(1) when developing or modifying AUC and describe how the entity meets the definition of PLE described in 42 CFR 414.94(b).
  • CMS has not provided an application template.
  • Send applications to by January 1

We will post qualified PLEs to our website.  All qualified PLEs must re-apply every five years and applications must be received by January 1 during the fifth year of their approval.

Qualified PLEs as of June 2019

American College of Cardiology Foundation
American College of Radiology
Banner University Medical Group-Tucson University of Arizona
The CDI Quality Institute doing business as (d/b/a) The RAYUS Quality Institute
Cedars-Sinai Health System
High Value Practice Academic Alliance
Intermountain Healthcare
Johns Hopkins University School of Medicine*
Medical Guidelines Institute
Memorial Sloan Kettering Cancer Center
National Comprehensive Cancer Network
Society for Nuclear Medicine and Molecular Imaging
Synergetic Professional Guidelines Institute*
University of California Medical Campuses
University of Pennsylvania Health System
University of Texas MD Anderson Cancer Center
University of Utah Health
University of Washington School of Medicine
Virginia Mason Medical Center
Weill Cornell Medicine Physicians Organization

* Indicates newly qualified PLEs as of June 30, 2019

Information Collections Under 42 CFR 414.94
OMB Control Number: 0938-1288
Expiration Date: 6/30/2019
Page Last Modified:
12/01/2021 08:00 PM