applicable payment system
(4) Consultation with applicable appropriate use criteria (A) Consultation by ordering professional Beginning with January 1, 2017 , subject to subparagraph (C), with respect to an applicable imaging service ordered by an ordering professional that would be furnished in an applicable setting and paid for under an applicable payment system (as defined in subparagraph (D)), an ordering professional shall— (i) consult with a qualified decision support mechanism listed under paragraph (3)(C); and (ii) provide to the furnishing professional the information described in clauses (i) through (iii) of subparagraph (B). (B) Reporting by furnishing professional Beginning with January 1, 2017 , subject to subparagraph (C), with respect to an applicable imaging service furnished in an applicable setting and paid for under an applicable payment system (as defined in subparagraph (D)), payment for such service may only be made if the claim for the service includes the following: (i) Information about which qualified clinical decision support mechanism was consulted by the ordering professional for the service. (ii) Information regarding— (I) whether the service ordered would adhere to the applicable appropriate use criteria specified under paragraph (2); (II) whether the service ordered would not adhere to such criteria; or (III) whether such criteria was not applicable to the service ordered. (iii) The national provider identifier of the ordering professional (if different from the furnishing professional). (C) Exceptions The provisions of subparagraphs (A) and (B) and paragraph (6)(A) shall not apply to the following: (i) Emergency services An applicable imaging service ordered for an individual with an emergency medical condition (as defined in section 1395dd(e)(1) of this title ). (ii) Inpatient services An applicable imaging service ordered for an inpatient and for which payment is made under part A. (iii) Significant hardship An applicable imaging service ordered by an ordering professional who the Secretary may, on a case-by-case basis, exempt from the application of such provisions if the Secretary determines, subject to annual renewal, that consultation with applicable appropriate use criteria would result in a significant hardship, such as in the case of a professional who practices in a rural area without sufficient Internet access. (D) Applicable payment system defined In this subsection, the term “applicable payment system” means the following: (i) The physician fee schedule established under section 1395w–4(b) of this title . (ii) The prospective payment system for hospital outpatient department services under section 1395l(t) of this title . (iii) The ambulatory surgical center payment systems under section 1395l(i) of this title .