Appropriate Use Criteria Program - Clinical Decision Support Mechanisms
Guidance for describing the particulars of Clinical Decision Support Mechanisms.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 10, 2020
NOTICE: As announced in the CY 2024 Physician Fee Schedule (PFS) Final Rule, effective January 1, 2024, CMS is pausing efforts to implement the AUC program for reevaluation and rescinding the AUC regulations at 42 CFR 414.94, reserving this section for future use. CMS has not specified a timeframe within which implementation efforts will recommence. See pages 79256-79265 of the final rule.
Effective January 1, 2024, providers and suppliers should no longer include AUC consultation information on Medicare FFS claims. Additionally, CMS will no longer qualify PLEs or CDSMs and will remove this information from the AUC website. The claims processing instructions and guidance for the educational and operations testing period will also be removed.
Background
A Clinical Decision Support Mechanism (CDSM) is an interactive, electronic tool for use by clinicians that communicates appropriate use criteria (AUC) information to the user and assists them in making the most appropriate treatment decision for a patient’s specific clinical condition. They may be modules within or available through certified electronic health record (EHR) technology.
Applicants Seeking CDSM Qualification
- Applications must document current adherence to the qualified CDSM requirements under 42 CFR 414.94(g)(1) OR how and when each requirement is reasonably expected to be met.
- CMS has not provided an application template.
- Send applications to ImagingAUC@cms.hhs.gov by January 1.
We will post qualified CDSMs to our website. All qualified CDSMs must re-apply every five years and applications must be received by January 1 during the fifth year of their approval.
Qualified Clinical Decision Support Mechanisms and Related Codes
(Additional information regarding codes is available on our Outreach and Education page in MLN Matters Article MM11268)
| Mechanism Name | Code |
|---|---|
| MedCurrent OrderWise® | G1002 |
| Medicalis Clinical Decision Support Mechanism | G1003 |
| Change Healthcare CareSelect™* | G1004 |
| Cranberry Peak ezCDS | G1008 |
| Stanson Health's Stanson CDS | G1010 |
| AgileMD's Clinical Decision Support Mechanism | G1012 |
| EvidenceCare’s ImagingCare | G1013 |
| InveniQA's Semantic Answers in Medicine™ | G1014 |
| Reliant Medical Group CDSM | G1015 |
| Speed of Care CDSM | G1016 |
| INFINX CDSM | G1018 |
| LogicNets AUC Solution | G1019 |
| Curbside Clinical Augmented Workflow | G1020 |
| E*HealthLine Clinical Decision Support Mechanism | G1021 |
| Intermountain Clinical Decision Support Mechanism | G1022 |
| Persivia Clinical Decision Support | G1023 |
| Radrite* | G1024 |
| OmniScient ® | G1011 |
| Optum CDSM | G1011 |
*Free Tool Available
Information Collections Under 42 CFR 414.94
OMB Control Number: 0938-1315
Expiration Date: 03/31/2020
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