Clinical Decision Support & Appropriate Use Criteria

What is Clinical Decision Support and Appropriate Use Criteria?

Effective Jan. 1, 2020, the Protecting Access to Medicare Act (PAMA) requires referring clinicians to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (CT, MR, Nuclear Medicine and PET) for Medicare outpatients — including those performed in the emergency department (ED). Calendar Year 2020 is an educational and operations testing period for the AUC program. Although there are no payment consequences during the 2020 calendar year, CMS encourages all stakeholders to learn, test, and prepare for the program.

A Clinical Decision Support Mechanism (CDSM) is an interactive, electronic tool for use by clinicians that communicates AUC information to the user and assists them in making the most appropriate treatment decision for a patient’s specific clinical condition. There may be existing modules within or available through your certified electronic health record (EHR) technology. Please consult your vendor to determine if one is available to you.

What if I don’t have a CDSM?

Advanced Radiology recognizes that some practitioners may not have access to a Clinical Decision Support Mechanism through their EHR. There are free tools you can use to consult a CDSM and the resulting Decision Support Number and HCPCS codes and modifiers can be sent to Advanced Radiology with your referral.

You may register to use the Care Select Imaging Open Access Portal by clicking on the following link: https://openaccess.careselect.org/registration

If you have already registered you can reach your account login page by clicking on the following link: https://sso.careselect.org/

User guides are available on the Care Select website that will help you navigate. When the consultation is complete, please send the Decision Support Number, HCPCS Code, and HCPCS Modifier along with the patient referral to us.