The Medicare AUC Program

Who Will Be Affected?
Anyone who orders or provides advanced imaging tests will be affected.1

  • Ordering professionals will be required to consult applicable AUC using a qualified clinical decision support mechanism (CDSM)
  • Furnishing professionals will be required to report on AUC consultation in Medicare claims

Which Tests Are Specified?
AUC will have to be consulted and documented to receive Medicare reimbursement for these advanced imaging tests.1,2

  • Radionuclide imaging (RNI)
  • Computed tomography (CT) scanning
  • Cardiac magnetic resonance (CMR) imaging
  • Other diagnostic imaging tests as specified

When Is the Deadline?
The expected effective date for compliance is January 1, 2020.1,a

From July 2018 through December 2019, healthcare providers will have the option to participate in a voluntary period of reporting AUC information to CMS.1

aDetails regarding the Medicare AUC program, including the implementation date, are subject to change without notice based on updates issued by CMS.

Which AUC Are Applicable?
CMS has identified a list of qualified provider-led entities that have developed applicable AUC. One of these is the American College of Cardiology Foundation, which helped develop the Multimodality AUC for Stable Ischemic Heart Disease.3,4

Which CDSMs Qualify for Use?
Please visit the CMS AUC page for a list of qualified CDSMs.5

Although qualified CDSMs have been selected, there are several point-of-care tools currently available. These tools are not yet classified as qualified CDSMs, but they can help identify which noninvasive cardiac imaging tests may be appropriate for patients at risk for CAD, using the applicable Multimodality AUC.