No. The Medicare Appropriate Use Criteria program for advanced diagnostic imaging is paused, and its implementing regulations are rescinded.
In the CY2024 Physician Fee Schedule final rule, published 16 November 2023 (88 FR 78818), CMS paused the AUC program for reevaluation and rescinded the regulations at 42 CFR 414.94 — effective 1 January 2024. Nothing AUC-related is required on any Medicare fee-for-service claim, and CMS no longer qualifies Clinical Decision Support Mechanisms.
The statute itself was not repealed. Section 218(b) of the Protecting Access to Medicare Act remains on the books, which is why CMS described the program as paused and reserved the regulation for future use.
For Medicare fee-for-service, the practical answer is: nothing.
No AUC consultation. No CDSM consultation. Nothing to transmit to the furnishing provider. The MIPS improvement activity that once rewarded voluntary AUC consultation was removed, so there is not even optional credit for it.
No G-code, no modifier, no AUC ordering-professional NPI. Payment is not contingent on any AUC data element. The CDSM G-codes (G1000–G1024) and modifiers (MA–MH, QQ) were terminated 31 December 2024.
CMS instructed Medicare Administrative Contractors to end-date all national and local AUC edits for dates of service on or after 1 January 2025, and stated that instruction supersedes all prior AUC guidance.
This covers Medicare fee-for-service under PAMA section 218(b) only. Medicare Advantage plans, commercial payers and some state programs run their own imaging utilization and prior-authorization requirements, many of which use appropriate-use-style decision support. Those are unaffected by this rescission. If a payer asks you for an imaging appropriateness check, that is a plan requirement, not the Medicare AUC program.
The program was mandated in 2014 and never once enforced. Ten years of start dates, delays, and finally a pause.
| Date | What happened | Detail |
|---|---|---|
| 1 Apr 2014 | PAMA enacted | Section 218(b) adds section 1834(q) to the Social Security Act, requiring consultation with appropriate use criteria before ordering advanced imaging. |
| 1 Jan 2017 | Statutory start date — missed | The consultation and reporting requirement was due to begin. CMS did not meet the deadline and it never took effect. |
| 1 Jan 2020 | Education and testing period begins | Reporting could be submitted but no claim was ever denied for AUC reasons. |
| 2020 – 2022 | Repeated delays | The testing period was extended for the COVID-19 public health emergency, then continued "until further notice". CMS stopped accepting CDSM and PLE qualification applications in late 2022. |
| 16 Nov 2023 | CMS pauses the program | The CY2024 Physician Fee Schedule final rule (88 FR 78818) pauses the program for reevaluation and rescinds the regulations at 42 CFR 414.94, reserving the section for future use. |
| 1 Jan 2024 | Rescission effective | Providers and suppliers are told to stop including AUC consultation information on Medicare fee-for-service claims. CMS stops qualifying CDSMs and PLEs and removes the list. |
| 31 Dec 2024 | Codes terminated | The CDSM G-codes (G1000–G1024) and AUC modifiers (MA–MH, QQ) are given a termination date in the CMS HCPCS file. |
| 1 Jan 2025 | Claim edits removed | CMS instructs Medicare Administrative Contractors to end-date all national and local AUC program edits (Transmittal 12508, CR 13485). |
There is no announced restart, and no rulemaking pointing to one.
The CMS AUC program page states that CMS has not specified a timeframe within which implementation efforts will recommence. Its commitment is only to keep looking for a workable approach and to propose any such approach through future rulemaking.
The CY2025, CY2026 and CY2027 Physician Fee Schedule rules contain no AUC program provisions. The single mention across all of them is the removal of the related MIPS improvement activity, because the program had ended and clinicians could no longer attest to it.
CMS stopped qualifying Provider-Led Entities and Clinical Decision Support Mechanisms, removed the qualified list, terminated the billing codes, and told contractors to delete the claim edits. Restarting would mean rebuilding all of it through new rulemaking.
The compliance reason went away. The clinical reason did not.
Imaging decision support is now something a practice adopts because ordering the study that actually answers the question saves a repeat visit, a delay, and avoidable radiation — not because a claim will be rejected without it. That is a better reason to adopt it, but it does mean the honest pitch changed: no vendor can truthfully tell you that you need imaging decision support for Medicare compliance today.
Pogosh CDS gives imaging guidance as one part of a broader answer that also covers labs, specialist routing and escalation. It presents that guidance in its own neutral terms — Preferred, Consider, Avoid — and does not reproduce the ACR Appropriateness Criteria rating tables, which are ACR intellectual property licensed case by case. See how it compares → · Terms defined in the glossary →
No. The Medicare AUC program for advanced diagnostic imaging is paused and its implementing regulations have been rescinded. In the CY2024 Physician Fee Schedule final rule (published 16 November 2023, 88 FR 78818), CMS paused the program for reevaluation and removed the regulations at 42 CFR 414.94, effective 1 January 2024. Nothing AUC-related is required on any Medicare fee-for-service claim.
No. There is no CDSM consultation requirement for Medicare fee-for-service, and CMS no longer qualifies Clinical Decision Support Mechanisms or Provider-Led Entities at all. CMS removed the qualified-CDSM list from its website. The concept of a CMS-qualified CDSM no longer exists for any Medicare purpose.
No. The CDSM G-codes (G1000 through G1024) and the AUC modifiers (MA, MB, MC, MD, ME, MF, MG, MH and QQ) carry a termination date of 31 December 2024 in the CMS HCPCS file. CMS instructed Medicare Administrative Contractors to end-date all national and local AUC edits for dates of service on or after 1 January 2025, in Transmittal 12508 (CR 13485).
No, and this distinction matters. Section 218(b) of the Protecting Access to Medicare Act of 2014 — codified at section 1834(q) of the Social Security Act, 42 U.S.C. 1395m(q) — remains on the books unamended. What CMS rescinded were the implementing regulations at 42 CFR 414.94. The statutory authority survives, which is why CMS described the program as paused and the regulation as reserved for future use rather than eliminated.
No. As of its last update, the CMS AUC program page states that CMS has not specified a timeframe within which implementation efforts will recommence. There has been no subsequent rulemaking proposing a restart: the CY2025, CY2026 and CY2027 Physician Fee Schedule rules contain no AUC program provisions. CMS has said only that it will continue looking for a workable approach and would propose any such approach through future rulemaking.
No — it means it is now a clinical and operational choice rather than a Medicare billing requirement. Ordering the study that answers the question still avoids repeat visits, delays and unnecessary radiation. What changed is the reason to do it: the compliance driver went away, the clinical one did not. Note also that Medicare Advantage plans, commercial payers and some state programs run their own imaging utilization and prior-authorization rules, which are unaffected by this rescission.
Everything above is checkable. If any of it has gone out of date, tell us at signal@gighz.com.
This page is a plain-language summary of public regulatory information, not legal or billing advice. Verify against the sources above before making a compliance decision.