• David E Winchester, Friederike K Keating, Krishna K Patel, and Nishant R Shah.
• Malcom Randall VAMC and University of Florida College of Medicine, Gainesville, Florida (D.E.W.).
• Ann. Intern. Med. 2023 Sep 1; 176 (9): 123512391235-1239.

BackgroundCongress established the Appropriate Use Criteria (AUC) Program to reduce unnecessary advanced imaging studies. Organizations that wish to develop AUC can apply to the Centers for Medicare & Medicaid Services (CMS) to qualify as provider-led entities (PLEs) under this program. Variable methods, content, and formatting of PLE-generated AUC could lead to clinician uncertainty about whether an advanced imaging test is appropriate or not.PurposeTo review AUC published by CMS-qualified PLEs focused on advanced imaging tests for coronary artery disease (CAD), a "priority clinical area" identified by CMS.Data SourcesPublicly available data from the worldwide web searched on 29 August 2022.Study SelectionApproved AUC with recommendations related to testing for CAD.Data ExtractionManual review of published AUC by all authors.Data SynthesisAmong the 17 CMS-qualified PLEs, only 7 had published AUC related to CAD. Substantial variation in the methods and formatting of these AUCs was observed. The number of clinical scenarios covered ranged from 6 to 210, and the number of advanced imaging methods covered ranged from 1 to 25. When specifically applied to clinical scenarios, many AUC offered no guidance on appropriateness; those that did conflicted with respect to appropriateness.LimitationOther CMS-identified priority clinical areas were not evaluated.ConclusionCMS-qualified AUC for imaging of CAD are heterogeneous and sometimes discrepant, creating substantial potential for uncertainty among clinicians seeking to provide their patients with appropriate imaging tests.Primary Funding SourceNo funding was received for this study.

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