Summary & Overview
HCPCS G1024: Clinical Decision Support for Appropriate Use Criteria
HCPCS Level II code G1024 denotes the use of a clinical decision support mechanism as defined by the Medicare Appropriate Use Criteria (AUC) program. The code captures instances when a point-of-care decision support tool is used to assess imaging appropriateness, which is increasingly important for accountable, evidence-based imaging utilization and Medicare program compliance. Nationally, use of AUC-linked decision support affects imaging ordering workflows, documentation requirements, and payer auditing practices.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how G1024 is positioned within clinical operations and payer interactions, including national-level considerations for reimbursement policy, documentation expectations, and common billing modifiers. The publication summarizes available benchmarks and policy context where present and identifies gaps where input data is not provided.
This article explains what the code represents, where it is typically reported (outpatient and ambulatory settings), and what stakeholders should expect when encountering G1024 on claims. It serves as a concise reference for billing teams, compliance officers, and clinical leaders seeking to understand the administrative role of clinical decision support reporting under AUC frameworks.
Billing Code Overview
HCPCS Level II code G1024 represents a clinical decision support mechanism defined by the Medicare Appropriate Use Criteria (AUC) program. The description indicates the code is used for documenting or reporting the use of an AUC-linked decision support tool that provides guidance at the point of care to inform imaging appropriateness.
Service Type: Clinical decision support service
Typical Site of Service: Outpatient and ambulatory care settings where imaging orders are placed, including physician offices, outpatient clinics, and other non-inpatient locations where AUC consultation is applied.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient radiology clinic or an ambulatory imaging center for decision support related to an advanced imaging order. The ordering clinician (typically an emergency physician, internist, cardiologist, or orthopedic surgeon) has entered a computed tomography (CT), magnetic resonance imaging (MRI), or nuclear medicine advanced imaging request into the electronic health record. The facility or imaging service uses a Medicare Appropriate Use Criteria (AUC) clinical decision support mechanism to evaluate the appropriateness of the requested advanced imaging study prior to scheduling or performing the exam. The clinical workflow: the provider orders the advanced imaging study in the EHR; the AUC system is triggered and returns a decision support response; the ordering provider documents the AUC interaction (including the patient’s clinical indication and the rationale if the AUC recommends a lower-utility option); the imaging facility schedules and performs the study if the order is approved; billing staff append billing code G1024 to indicate the use of the AUC clinical decision support mechanism per the Medicare Appropriate Use Criteria program when submitting claims.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | Use if additional work or complexity was documented for services related to the imaging encounter beyond typical AUC consultation documentation. |