AUC Mandate News: Drop AUC Consultation Information from Medicare Fee-for-Service Claims, CMS Says

Throughout the nearly nine years since the Protecting Access to Medicare Act established the Appropriate Use Criteria (AUC) Program for advanced diagnostic imaging, ASNC has been a vocal opponent of the program and led a coalition of medical societies that fought the administratively burdensome program. In the 2024 Medicare Physician Fee Schedule final rule, the AUC Program was paused and all of its regulations were rescinded. Now, the Centers for Medicare & Medicaid Services (CMS) has informed providers and suppliers that they should no longer include AUC consultation information on Medicare fee-for-service claims.

In a notification to contractors and a Medicare Learning Network (MLN) Matters article issued in early 2024, CMS states that claims containing AUC-related codes with 2023 and 2024 dates of service will be processed; however, all AUC-related codes and modifiers will end Dec. 31, 2024. Contractors are instructed to remove all national and local edits related to the AUC Program effective Jan. 1, 2025. CMS also states that it will no longer qualify provider-led entities or clinical decision support mechanisms.

It is unclear what is next for the AUC Program, though modifications to overcome the implementation challenges that plagued the mandate would likely require changes to the law by Congress.

Stay tuned to ASNC for updates on the AUC Program and other advocacy issues.

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AUC Mandate News: Drop AUC Consultation Information from Medicare Fee-for-Service Claims, CMS Says

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