Provider Led Entities

Provider Led Entities
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.


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 May 2023

American College of Cardiology Foundation
American College of Radiology
The CDI Quality Institute doing business as (d/b/a) The RAYUS Quality Institute
Duke University Health System*
High Value Practice Academic Alliance
Intermountain Healthcare
Johns Hopkins University School of Medicine
Memorial Sloan Kettering Cancer Center
National Comprehensive Cancer Network
Society for Nuclear Medicine and Molecular Imaging
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
Weill Cornell Medicine Physicians Organization

* Indicates newly qualified PLEs as of June 30, 2022

Information Collections Under 42 CFR 414.94
OMB Control Number: 0938-1288
Expiration Date: 6/30/2019
Page Last Modified:
09/06/2023 04:57 PM