MLN Matters: MM13485 Related CR 13485
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Since 2015, CMS has worked to implement the statutory requirements in notice and comment
rulemaking and the Program has operated in the educational and operations testing period on
January 1, 2020, during which there were no payment penalties.
We created a number of HCPCS G codes to identify Clinical Decision Support Mechanisms and
modifiers to help implement the AUC Program. These G codes include G1000 ─ G1024 and
modifiers include MA ─ MH and QQ.
The AUC Program, as authorized in PAMA, required practitioners that order advanced
diagnostic imaging services to consult AUC using an electronic Clinical Decision Support
Mechanism (CDSM) tool when ordering these imaging services. Practitioners that provide the
imaging services reported the AUC consultation information obtained by the ordering
practitioner on the claims for the imaging services.
We finalized in the CY 2024 PFS final rule a pause to the AUC Program for reevaluation. We
also rescinded the current AUC Program regulations at 42 CFR 414.94 and reserved this
section of the regulations for future use. As described in the CY 2024 PFS final rule, we’ve
exhausted all reasonable options for fully operationalizing the AUC Program consistent with the
statutory provisions directing us to require real-time claims-based reporting to collect information
on AUC consultation as a condition of payment and identify imaging patterns for advanced
diagnostic imaging services to ultimately inform outlier identification and prior authorization.
We aren’t specifying a time frame for the start of programmatic and operational efforts. We’ll
continue efforts to identify a workable approach and will propose to adopt any such approach
through subsequent rulemaking, including implementing any amendments Congress might
make to the AUC Program statutory provisions.
Effective January 1, 2024, providers and suppliers should no longer include AUC consultation
information on Medicare FFS claims. However, claims containing AUC-related codes with dates
of service in 2023 and 2024 will continue to process.
Also, we’ll no longer qualify provider-led entities (PLEs) or CDSMs and have removed this
information from the AUC website. The claims processing instructions and guidance for the
previous voluntary period and educational and operations testing period will be removed, but
archived versions will continue to be available at CMS Transmittals
.
Consistent with the AUC Program pause and reevaluation authorized in the CY 2024 PFS final
rule, we’re instructing MACs and our shared system maintainers (SSMs) to:
• Remove and archive systems edits related to the AUC Program
• Process any advanced imaging claims that erroneously include AUC Program
G codes G1000 ─ G1024 or modifiers MA ─ MH and QQ
• Not reject or return claims to providers because of such erroneous attachment through
CY 2024
Our plan is to end the above described HCPCS G codes and modifiers, effective December 31,
2024, to assist in claims processing and data analysis.