Appropriate Use Criteria

"AUC are a set of individual criteria that present information in a manner that links a specific clinical condition or presentation, one or more services, and an assessment of the appropriateness of the service(s). Evidence-based AUC for imaging can assist clinicians in selecting the imaging study that is most likely to improve health outcomes for patients based on their individual context." - Centers for Medicare and Medicaid Services, MPFS CY 2017

Eight Clinical Priority Areas

Although all ordering professionals must consult CDS for advanced outpatient imaging, CMS has identified eight priority clinical areas that must be reported starting January 1, 2018. The eight clinical areas are:

  • Coronary Artery Disease (suspected or diagnosed)
  • Suspected Pulmonary Embolism
  • Headache (traumatic or non-traumatic)
  • Hip Pain
  • Low Back Pain
  • Shoulder Pain (to include suspected rotator cuff injury)
  • Cancer of the Lung (primary or metastatic, suspected or diagnosed)
  • Cervical or Neck Pain