Understanding Changes to Medicare’s Advanced Diagnostic Imaging Guidelines

The Centers for Medicare & Medicaid Services (CMS) recently made a significant decision regarding the Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging. Following a thorough review and public feedback, including strong arguments from the American Society of Nuclear Cardiology (ASNC), CMS has decided to suspend the AUC Program. This move marks the end of the program’s trial phase, which aimed to assess its effectiveness and practicality.

ASNC, in their September feedback to CMS, pointed out several fundamental flaws in the program’s design, as initially outlined by Congress. Their critique played a crucial role in shaping CMS’s ultimate decision.

In the latest ruling, CMS acknowledged a key standpoint that ASNC has long held: the principles of AUC are already integrated into existing Medicare quality programs. Therefore, maintaining a separate, isolated AUC program for advanced diagnostic imaging isn’t just redundant, but also less efficient. The final rule emphasized this, stating that while a dedicated program for AUC consultation in advanced diagnostic imaging services would directly address the objective of improving ordering patterns, recent experiences show that these goals are better achieved through other comprehensive CMS quality initiatives.

While CMS has paused the AUC Program and is considering its future, they have not specified when or how they might revisit its implementation.

For a more detailed understanding of the implications of this change, especially in relation to the 2024 Medicare Physician Fee Schedule, visit the ASNC blog: ASNC 2024 Medicare Physician Fee Schedule.

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