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Clinical Decision Support

The Protecting Access to Medicare Act (PAMA) requires referring providers to consult Appropriate Use Criteria (AUC) before ordering advanced diagnostic imaging services such as CT, MR, Nuclear Medicine and PET - for Medicare patients.

The AUC program mandates that when ordering advanced imaging services, the referring provider must consult a Clinical Decision Support Mechanism (CDSM). The referring provider must provide the appropriate documentation to the imaging facility so that the AUC consultation information is reported on the Medicare claim.

The implementation date for Clinical Decision Support (CDS) is January 1, 2023, however, the Centers for Medicare and Medicaid Services has implemented a test period for the remainder of 2022.

Referring providers that order advanced diagnostic imaging services for Medicare patients must use a qualified Clinical Decision Support Mechanism (CDSM) to consult AUC. Atlantic Medical Imaging has partnered with Cranberry Peak (G1008) to provide referring physicians access to ezCDS, an interactive, easy to use CSM.

ezCDS will:

  1. Check appropriateness for an imaging study and assign a modifier.
  2. Identify the appropriate imaging study based on the indications you provide.

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Click here to access ezCDS

Frequently Asked Questions

  • What is a Clinical Decision Support Mechanism (CDSM)?
    A Clinical Decision Support Mechanism (CDSM) is an interactive, electronic tool for use by clinicians that communicates appropriate use criteria information to the user and assists them in making the most appropriate treatment decision for a patient’s specific condition.
  • How do I access the ezCDS?
    To access the ezCDS Portal, click here. AMI will provide your login credentials.
  • Can AMI access the Clinical Decision Support Mechanism on behalf of referring provider?

    No, the Appropriate Use Criteria consultation must be performed by the referring provider’s office.

  • If my patient has Medicare Part B or Railroad Medicare as a secondary insurance, do I need to consult Appropriate Use Criteria?

    Yes, referring providers must consult Appropriate Use Criteria for patients with Medicare Part B and Railroad Medicare listed as secondary insurance.

  • Do all medical providers have to participate with Clinical Decision Support?

    Yes, all medical providers that order imaging exams for patients that have Medicare Part B or Railroad Medicare as either primary or secondary insurance must comply with the AUC Mandate unless they qualify for a hardship. Hardships are: insufficient internet access, electronic Medical Records or CDSM issues or extreme and uncontrollable circumstances.

  • What advanced imaging exams does the Appropriate Use Criteria Mandate apply to in an office setting?

    All CT and MRI exams ordered by a medical provider for patients that have primary or secondary Medicare Part B and Railroad Medicare insurance.

  • Do Medicare Advantage Plans have to comply with the Appropriate Use Criteria /Clinical Decision Support mandate?

    No, the mandate does not apply to Senior Managed Insurance Plans.

  • Will you provide services to my Medicare Part B and Railroad Medicare patients if the Appropriate Use Criteria information is no

    No, AMI will not be able to accommodate Medicare Part B and Railroad Medicare referred patients without the proper AUC documentation, as stated in the Appropriate Use Criteria Mandate.

  • What information will the ezCDS Clinical Decision Support Mechanism ask for?

    You will need to provide information about the patient’s encounter including the test being ordered and the clinical indications and symptoms. Based on what is entered, an appropriateness score will be generated.

  • How will the qualified Clinical Decision Support Mechanism information get communicated AMI?

    The referring provider is responsible for providing the Appropriate Use Criteria consultation information to AMI as part of the electronic order or manually writing it on the patient’s script.

  • What information will the referring provider need to provide to AMI?

    The referring provider will need to provide the G-code for the Clinical Decision Support Mechanism used (Cranberry Peak – G1008) and Modifier for whether the result of the consultation was “adhere”, “not adhere”, or “not applicable.

    Click here for list of Modifiers

  • Can AMI to look up AUC consultation information if the referring provider forgot to provide it on the referral slip?

    Yes, AMI has access to the list of CDS consultations, including referring provider info (e.g. name, NPI), imaging study ordered, and date/time. In addition, each consultation has a unique identifier. If you have the unique identifier available, AMI can look up all the details for that particular CDS consultation, including modifier, G-code.

  • Is there a cost to use the ezCDS Qualified Decision Support Mechanism?

    No, there is no fee for the referring provider.

  • Where can I find more information about Clinical Decision Support?

    Please visit www.acr.org/cds for more information.

  • Who can I contact at AMI if I have any questions?

    Please contact your AMI Provider Relations Representative with any questions or concerns that you may have or you can email marketing@aminj.com for further assistance.

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