The Centers for Medicare and Medicaid Services (CMS) announced that the payment penalty phase of the appropriate use criteria (AUC) consultation mandate will not begin Jan. 1, 2023 nor the January 1 following the end of the COVID-19 public health emergency as planned. CMS states that it is “unable to forecast when the payment penalty phase will begin.”
The Protecting Access to Medicare Act (PAMA) requires referring clinicians to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (CT, MR, Nuclear Medicine and PET) for Medicare outpatients — including those performed in the emergency department (ED).
The ACR will continue to work with CMS to solve the logistical issues preventing full implementation of this important quality program that will ensure Medicare patients receive the right imaging at the right time.
Below are suggested resources and activities to help Advanced Practice Providers (including nurse practitioners and physician assistants) become familiar with the PAMA requirements.