2017 Fee Schedule Released: CMS Finalizes Major Components of AUC Program

November 2, 2017, the Centers for Medicare and Medicaid Services (CMS) issued its final 2017 payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS).  Payment rates and policies set forth in these rules are effective Jan. 1, 2017.
Most notably, the PFS rule finalizes requirements and processes for specification of qualified clinical decision support mechanisms (CDSMs) under the Medicare Appropriate Use Criteria (AUC) program and finalizes the initial list of priority clinical areas that will be used to identify outlier ordering professionals.

“The Medicare Appropriate Use Criteria program is one of the most consequential programs for Nuclear Cardiology in recent Medicare history,” said Dr. Brian Abbott.  “The sheer complexity of the law is evident in CMS' rulemaking. ASNC is committed to working with CMS to implement the law in manner such that it does not impose undue administrative burdens and costs to both ordering and furnishing providers and does not compromise beneficiary access to the right test first.” 

Key AUC Provisions in the Final Rule
  • CMS agreed with ASNC that chest pain was too broad as a clinical priority area and instead finalized coronary artery disease and suspected pulmonary embolism as clinical priority areas.
  • Clinical decision support mechanisms must incorporate specified, applicable AUC that comprise the entire clinical scope of all priority clinical areas. 
  • CMS agreed with ASNC's comments that the order must identify which AUC were consulted
  • The first eight clinical priority areas will be 1). Coronary artery disease (suspected or diagnosed); (2) Suspected pulmonary embolism; (3) Headache (traumatic and non-traumatic); (4) Hip pain; (5) Low back pain; (6) Shoulder pain (to include rotator cuff injury); (7) Cancer of the lung (primary or metastatic, suspected or diagnosed); and (8) cervical or neck pain. 
ASNC is conducting a detailed analysis of the final rule and will provide it to members in the coming days. 

View the MPFS final rule in its entirety
View the MPFS fact sheet