Medicare Use

Who Is Affected?

Any practitioner who orders Medicare Part B advanced diagnostic imaging services will be affected.

  • MRI
  • CT
  • PET
  • Nuclear Medicine

What Is The Program?

The “Protecting Access to Medicare Act” (PAMA) of 2014 established a new program to increase the affected rate of appropriate advanced diagnostic imaging services provided to Medicare beneficiaries. The affected imaging services will include; Computed Tomography (CT), Positron Emission Tomography (PET), Nuclear Medicine, and Magnetic Resonance Imaging (MRI).

When Does It Start?

The program will begin with an education testing period on January 1st, 2020. It will be fully implemented by January 1st, 2021. Referring physicians and their staff should become familiar with Appropriate Use Criteria (AUC) and applicable Clinical Decision Support Mechanism (CDSM) as soon as possible to ensure they are prepared.

To access a FREE Medicare Appropriate Use Criteria mechanism, click here

How Does It Work?

The practioner or clinical staff member who orders advanced imaging services must constult a qualified CDSM. CDSMs are an electronic portal which enable practitioners to access AUC during the patient workup. The CDSM will provide the referring professional with a determination whether they order adheres to, or does not adhere to AUC. Contact your EMR/EHR provider to find out if they have an interface, or plan to interface with a CDSM. If not, a list of qualified CDSMs is available here

Why Should You Do This?

This will be a mandatory program in 2021. It is best to ensure that practitioners and staff have a full understanding of the program BEFORE it is implemented. In addition to identifying outliers, Medicare Part B doctors must report quality measures under the Merit Based Incentive Payment System (MIPS). What practitioners do in MIPS in 2019 can impact their practice positively or negatively in 2021. The MIPS website is

ZWANGER-PESIRI RADIOLOGY strives to help our referring offices prepare for the ever changing medical landscape. We will do our best to act as a resource to help you comply with these new requirements.

If you have any questions, please call (631) 444-5544 ext. 4330.