Penn Medicine · Imaging AUC

Imaging Appropriate Use Criteria (AUC) Program

Penn Medicine is an organization comprised primarily of providers and practitioners who predominantly provide direct patient care.  It includes more than 5,300 faculty physicians, 8,100 nurses, and 1,300 physicians in training who provide care for patients through 1.2 million radiology procedures, 3.7 million outpatient visits, 304,000 emergency department visits, and 117,000 inpatient admissions annually. U.S. News & World Report ranks our flagship medical center in the Top 10 nationally, and all five Penn Medicine acute-care hospitals are ranked among the top 15 in Pennsylvania.

The Protecting Access to Medicare Act of 2014, mandates that all advanced diagnostic imaging services have to undergo an appropriate use criteria (AUC) consultation through a clinical decision support mechanism (CDSM) for all Medicare patients prior to the completion of the imaging service in order to receive Centers for Medicare and Medicaid Services (CMS) reimbursement. AUC are defined as evidence-based criteria that assist ordering professionals to make to the most appropriate treatment decisions for specific clinical conditions. Only AUC developed by entities meeting qualified provider-led entity (qPLE) standards can be used.  Penn Medicine was designated a qPLE in June 2018 by CMS.

Penn Medicine satisfies the criteria for a qualified PLE as specified in 42 CFR 414.94 paragraph (c) with the following:

1. Led by a multidisciplinary team
2. Management of conflicts of interest
3. Formal topic development process
4. Formal evidentiary review process
5. Publication of the Appropriate Use Criteria
6. Public comment form