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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).

Additional policies related to this program are included in the CY 2017 PFS Final Rule, which is available at https://www.gpo.gov/fdsys/pkg/FR-2016-11-15/pdf/2016-26668.pdf (pages 80403-80428 and pages 80554-80555).

The CY 2018 PFS Final Rule includes requirements for consulting and reporting under the Medicare AUC program, and is available at https://www.gpo.gov/fdsys/pkg/FR-2017-11-15/pdf/2017-23953.pdf (pages 53187-53201 and page 53363).

These policies are codified in our regulations at 42 CFR 414.94.

Questions regarding this program may be submitted to the CMS Imaging AUC resource box: ImagingAUC@cms.hhs.gov.

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