AUC Programs Ensure Patients Receive the Right Imaging at the Right Time

The Protecting Access to Medicare Act (PAMA) appropriate use criteria (AUC) program is an evidence-based delivery approach that is good for patients, providers and taxpayers. The AUC program has not been repealed but has been paused while Congress considers legislative improvements to the program.

The American College of Radiology® (ACR®) and the Centers for Medicare and Medicaid Services (CMS) strongly urge providers that have already implemented clinical decision support (CDS) programs to continue use during this pause.

Benefits of the AUC program include:

Supporting physicians and non-physician providers (such as Nurse Practitioners and Physician Assistants) to make the best clinical decisions around appropriate use of imaging.

Optimizing patient care by guiding providers’ determinations of a patient’s advanced imaging needs using physician-developed criteria.

Providing enhanced diagnostic accuracy, reducing delays in access and improving health outcomes.

Alternative cost-saving solutions could hurt providers and Medicare patients.

Prior authorization imposes tremendous administrative burdens on physician practices and shifts costs onto physicians. In addition, it takes medical decisions out of doctors’ hands and may delay or deny lifesaving care to those who need it.

The legislative fix to the AUC program is simple and on the horizon.

ACR is working with Congress and CMS to modernize the PAMA AUC program and remove the real-time claims processing requirement that has resulted in the current pause. ACR urges CMS to continue to work with national medical associations, provider groups and other stakeholders to implement the AUC mandate with the expected legislative changes potentially enacted in 2024. Get more information about the issues on our Clinical Decision Support Page.


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Webinar | Appropriateness Criteria and Clinical Decision Support: Good for Patients, Providers and Healthcare Facilities

With the Protecting Access to Medicare Act (PAMA) appropriate use criteria (AUC) program paused, healthcare providers may be unsure if they should continue using AUC and Clinical Decision Support (CDS). Hear from panelists on how they are using AUC/CDS as a tool to replace imaging pre-authorization; to optimize imaging use in the inpatient and outpatient settings; and in quality improvement initiatives.

Access the on-demand webinar

AUC FAQ

What are appropriate use criteria (AUC)?
  • These are physician-developed guidelines clinically oriented to guide decision making about when a medical procedure/service/test would be appropriate or not, and which exam or procedure is most appropriate for the patient’s condition, illness or injury.
  • AUC are created and maintained by professional societies/other entities.
What is the Protecting Access to Medicare Act (PAMA)?
  • In 2014, Congress passed the Protecting Access to Medicare Act (PAMA) to ensure millions of seniors could maintain access to critical health services.
How are PAMA and the AUC program connected?
  • PAMA requires an AUC consult to be performed via a CMS-qualified clinical decision support mechanism (qCDSM) when ordering advanced diagnostic imaging for Medicare patients.
How does AUC save money and benefit Medicare?
  • The process reduces and/or eliminates inappropriate advanced imaging services from being performed, thus saving Medicare money.
When and why was the AUC program paused?
  • The 2024 Medicare Physician Fee Schedule final rule, released November 2023, called for a pause to the PAMA AUC program due to continued concerns with the real-time claims processing aspect of the statute.
  • ACR is working with Congress in hopes of a legislative fix in 2024.
What can be done?
  • The real-time claims processing requirement can easily be addressed by a simple statutory change to the law.
Why should providers continue to use AUC?
  • The PAMA AUC law has not been repealed, only paused.
  • CMS encourages the continued voluntary use of CDS tools.
  • With a legislative fix in 2024, providers will be better prepared to meet the AUC mandate when the program moves forward.
What happens if there isn’t a legislative fix? Why should providers continue to invest in AUC programs and technology?
  • Regardless of the CMS AUC mandate, this CDS system has numerous benefits for providers and patients.
  • While the PAMA statute only applies to imaging performed in physician offices and hospital outpatient settings, hospital systems can use CDS for inpatient care as well, leading to more efficient care for all hospital patients.
  • Compared to alternatives such as prior authorization, which imposes huge administrative burdens on physician practices and shifts costs onto physicians, AUC systems optimize patient care by guiding providers’ determinations of a patient’s advanced imaging needs.
  • In an era of workforce shortages, CDS can help providers order the most appropriate exams and help prevent critical findings from being delayed.
Why is the ACR’s AUC program so useful?
  • It is multispecialty, physician-developed, evidence-based and transparent.
  • The ACR’s AUC guidance is considered the most comprehensive for imaging.
  • In 2023, ACR’s AUC provided 233 diagnostic imaging and interventional radiology topics with over 1,100 variants and, for Diagnostic Imaging topics, there were 3,000 clinical scenarios.
  • The guidelines are developed and reviewed annually by expert panels in diagnostic imaging and interventional radiology. Each panel includes leaders in radiology and other specialties.