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Upcoming CMS Appropriate Use Criteria Policy For Ordering Advanced Imaging Raises Concerns

 
• By Sue Darcey

Medical specialty groups are raising concerns about a planned policy change in 2020 by the US Medicare agency to require use of clinical decision support mechanism (CDSM) software to ensure physicians review appropriate use criteria before ordering advanced imaging scans.

7T MRI scanner Magnetom Terra from Siemens Healtineers
Before ordering advanced imaging via MRI scanners, such as the Siemens Magnetom Terra pictured above, physicians would have to first consult appropriate use criteria software

Physician groups are worried about a planned New Year's Day launch of a new reimbursement policy by the US Centers for Medicare and Medicaid Services (CMS) that will require doctors to use appropriate use criteria (AUC) software prior to ordering advanced imaging for their patients.

Under the policy – which begins on 1 January 2020 and is required under the Protecting Access to Medicare Act of 2014 (PAMA) – Medicare will only cover advanced imaging orders for beneficiaries if the attending physician first wins approval for the scan

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