Appropriate Use Criteria Claims Processing Requirements Issued

December 09, 2019


CMS issues the claims processing requirements for the voluntary educational and operational testing period – set to begin on January 1, 2020 – for the Appropriate Use Criteria for Advanced Diagnostic Imaging.

The transmittal includes the G codes that are to be reported to identify the specific clinical decision support mechanism(s) (CDSM) consulted as well as the HCPCS modifiers that have been established to describe the level of adherence to the AUC.

CMS is encouraging participation during this testing period but notes that claims will not be denied for failing to include AUC-related information.

AUC for Advanced Diagnostic Imaging – Educational and Operations Testing Period – Claims Processing Requirements

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