August 3, 2017
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has published appropriate use criteria (AUC) for hepatobiliary scintigraphy in abdominal pain. This is the third in a series of new AUC developed by SNMMI in its role as a qualified provider-led entity (PLE) under the Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging. The other recently released AUC are for bone scintigraphy in prostate and breast cancer and for ventilation/perfusion (V/Q) imaging in pulmonary embolism, which is endorsed by the American College of Emergency Physicians. In addition, the AUC for F-18-FDG PET restaging and response assessment of malignant disease has been approved by the SNMMI Board and will soon be available online and will be published in The Journal of Nuclear Medicine.
The new AUC are intended to assist referring physicians and ordering professionals in fulfilling the requirements of the 2014 Protecting Access to Medicare Act (PAMA). Current regulations call for PAMA to require referring physicians to consult AUC developed by a PLE beginning January 1, 2018, to ensure cost-effective and appropriate utilization of advanced diagnostic imaging services. However, the Centers for Medicare & Medicaid Services recently proposed pushing back the start date for when providers will be required to consult AUC to January 2019.