Appropriate Use Criteria for Advanced Imaging

This information is available for medical providers use

Appropriate Use Criteria (AUC), specify when it is appropriate to perform a medical procedure or service.

As part of the Protecting Access to Medicare Act (PAMA), beginning January 1, 2020, providers who order Medicare Part B advanced diagnostic imaging services must consult, but not adhere to, Appropriate Use Criteria (AUC) through a qualified Clinical Decision Support Mechanism (CDSM). Furnishing providers must then report AUC consultation information on their Medicare claims. A consultation must take place at the time of the order for imaging services that will be performed in the physician office, independent diagnostic testing facility, hospital outpatient (including emergency department) and ambulatory surgery center settings. As the ordering professional, you may delegate the AUC consultation to clinical staff acting under your direction if you do not personally perform the AUC consultation yourself.

Advanced diagnostic imaging services are defined as diagnostic magnetic resonance imaging, computed tomography, and nuclear medicine (including positron emission tomography and stress tests).

Beginning January 1, 2022, Medicare claims for imaging services (both technical component and professional component) will be denied if AUC consultation is not performed.

Since 2020, CCH implemented AUC documentation in stages. Effective October 1, 2021, AUC is required.

Any orders received without AUC information included will be faxed back to the provider, along with instructions on how to complete this for CCH. Services will not be provided for the patient without completed AUC documentation.

If you have questions when completing the order, please reach out to the CCH Radiology Department at (307) 688-1600.

CMS has provider education materials on cms.gov; search Appropriate Use Criteria Program.

For help or to set up additional training, please contact it_training_team@cchwyo.org.

CareSelect Imaging Open Access Portal

To be compliant with the Protecting Access to Medicare Act, Campbell County Health is now requiring the submission of Appropriate Use Criteria (AUC) consult data with the submission of advanced imaging orders, including PET, CT, MRI, and Nuclear Medicine. If your current EMR is not enabled with AUC consult functionality or if your office uses paper requisitions, please use the CareSelect Imaging Open Access Portal provided by CCH.

To access the CareSelect Imaging Open Access Portal for the first time, navigate to https://openaccess.careselect.org/registration and register for an account. To register, you will provide basic information, including your name, NPI (if a provider registration), email, etc. Once your registration is complete, you will be able to log into the application.

To access the CareSelect Imaging Open Access Portal post registration, navigate to https://openaccess.careselect.org and enter the username and password created during your initial registration.