1999-2004

Cardiac imaging increased exponentially in the United States, but usage varied widely by region. To control growth and cost, payers initiated radiology benefits management programs using precertification and prior notification.7-9

This raised concerns regarding10:

  • Indiscriminate volume reduction
  • Lack of transparency
  • Inconsistent processes
  • No appropriateness criteria

The professional imaging community decided it would be better to self-regulate and develop AUC for cardiac imaging tests.10

2005

The American College of Cardiology partnered with several professional societies to develop AUC for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI).11

Since then, AUC for other individual modalities have been developed.5

2013

The Multimodality AUC were developed, expanding to include appropriateness ratings for 7 cardiac testing modalities across 80 common patient indications.5

These Multimodality AUC replace prior AUC.5

2014

The Protecting Access to Medicare Act of 2014 directed CMS to establish a program promoting the use of AUC for advanced diagnostic imaging services.12

2015-2017

The CMS introduced the Medicare AUC Program and began implementation in a stepwise approach. Soon, for advanced imaging services provided to Medicare beneficiaries in the outpatient setting, applicable AUC will have to be consulted and documented using a qualified clinical decision support mechanism.1,3

Looking Ahead

July 2018-December 2019a

Healthcare providers will have the option to participate in a voluntary period of reporting AUC information to the CMS.2

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

January 1, 2020a

Ordering providers will be required to consult AUC; furnishing providers will be required to submit documentation about AUC.2

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

AUC are not intended to be used as a substitute for sound clinical judgment and practice experience, as the selection of appropriate imaging procedures may be influenced by local parameters. The ultimate objective of AUC is to improve patient care and health outcomes in a cost-effective manner.5