Appropriate Use Criteria

The six AUC Priority Clinical Areas (PCA) were developed by physicians from the five medical campuses of the University of California: Davis, Irving, Los Angeles, San Diego, and San Francisco.  

In accordance with Center for Medicare Services (CMS) CY 2017 PFS final rule, our AUCs meet the minimum requirement to “reasonably address common and important clinical scenarios” within Priority Clinical Areas (PCA) for CDSMs to be considered qualified. Each AUC document indicates the PCA(s) for which it meets this minimum requirement for qCDSM coverage. Additionally, as described by CMS in the CY 2016 PFS final rule in §414.94(c)(1)(v), QPLEs are required to identify AUC that are “relevant” to a PCA. Relevance is defined as an AUC that “reasonably addresses the entire clinical scope” of the area. Where an AUC meets this definition of relevance it is noted in the AUC document.

Note that the majority of UC AUC related to a PCA do not meet the CY 2016 PFS definition of “relevant.” However, there is no requirement for qualified CDSM to use “relevant” AUC. Since the UC AUC related to a PCA do “reasonably address common and important clinical scenarios,” they may be used to meet the §414.94(g)(1)(iii) CDSM qualification requirement for addressing PCAs.

The UC AUCs are available for licensing. Contact Peter Vigil, MS, MA, QPLE Coordinator (peter.vigil@ucsf.edu).