CMS Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging

The Centers for Medicare & Medicaid Services (CMS) released today (7/26/2019), a notification for Medicare Administrative Contractors (MACs) that effective January 1, 2020, MACs should accept the Appropriate Use Criteria (AUC) related HCPCS modifiers on Medicare claims for outpatient advanced diagnostic imaging procedures.

DHHS / CMS / MLN Matters

July 26, 2019

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News & Resources

The Centers for Medicare & Medicaid Services (CMS) released today (7/26/2019), a notification for Medicare Administrative Contractors (MACs) that effective January 1, 2020, MACs should accept the Appropriate Use Criteria (AUC) related HCPCS modifiers on Medicare claims for outpatient advanced diagnostic imaging procedures. The MLN Matters article is uploaded to this post providing an overview along with relevant CPT codes, modifiers and G codes to be used by suppliers of advanced imaging services. Calendar year 2020 is being used for educational and operational testing, therefore claims will not be denied for failing to include AUC related information. For more information on AUC, please visit the CMS website’s section on Appropriate Use Criteria Program. CMS AUC

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