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Provider Led Entities

Background

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 ImagingAUC@cms.hhs.gov 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
CDI Quality Institute
Cedars-Sinai Health System
High Value Practice Academic Alliance
Intermountain Healthcare
Johns Hopkins University School of Medicine*
Massachusetts General Hospital, Department of Radiology
Medical Guidelines Institute
Memorial Sloan Kettering Cancer Center
National Comprehensive Cancer Network
Sage Evidence-based Medicine & Practice Institute
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