Priority Clinical Areas

Priority Clinical Areas
NOTICE: The payment penalty phase will not begin January 1, 2023 even if the PHE for COVID-19 ends in 2022. Until further notice, the educational and operations testing period will continue. CMS is unable to forecast when the payment penalty phase will begin.

NOTICE: All CDSMs and PLEs qualified as of July 2022 will remain qualified through this cycle. Applications for initial qualification or re-qualification will not be accepted for the 2023 application cycle.


Priority clinical areas are defined in 42 CFR 414.94(b) 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 (data used to inform this rule is available at Proposed_Priority_Clinical_Area_Appendix2 (PDF)) and established the list in 42 CFR 414.94(e)(5).

Priority Clinical Areas as of November 2016

  • 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


Page Last Modified:
09/06/2023 04:57 PM