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Appropriate Use Criteria Program - Outreach and Education

Guidance for documentation related to MLN Matters Articles, Change Requests (CRs) and Open Door Forums.

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. 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. However, claims containing AUC related codes with dates of service in 2023 and 2024 will continue to process. 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.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.