AUC criteria are developed and endorsed by national professional medical specialty societies or other provider-led entities (PLEs), and are meant to guide ordering and furnishing professionals to make the most appropriate treatment decision for the patient given the specific clinical condition or indication.
Throughout 2020, claims payments will not be impacted and no penalties will be incurred, i.e., claims will continue to be paid even when evidence of consultation of AUC is missing or entered incorrectly. Starting January 1, 2021, full implementation of the CMS program will require evidence regarding the ordering provider's consultation using a qCDSM. AUC consultation information must be appended to professional and facility claims for the service in order for the claim to be paid. Although full details aren't yet available, penalties may be applied to claims submitted without evidence of AUC consultation for Medicare Part B advanced diagnostic imaging services furnished to Medicare FFS patients.
for comprehensive information and to learn more about CMS's AUC program.