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until the CMS Appropriate Use Criteria Program begins.

The Protecting Access to Medicare Act (PAMA) of 2014, Section 218(b), established a new program to increase the rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries.

Under this program, at the time a practitioner orders an advanced diagnostic imaging service for a Medicare beneficiary, he or she will be required to consult a qualified Clinical Decision Support Mechanism (CDSM), which determines whether the order adheres to Appropriate Use Criteria (AUC).

The program is currently in an “Education and Operations Testing” period. This has been extended through December 2021. 

The program is expected to be fully implemented January 1, 2022. At this time, any providers or practices who do not submit AUC information for advanced imaging services could have the exam requisition refused or returned.

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