Radiology Outpatient Ordering Transmission (ROOT) Act
The Radiology Outpatient Ordering Transmission (ROOT) Act would revise Medicare’s appropriate use criteria process for applicable imaging services, which are certain advanced imaging tests ordered for Medicare beneficiaries. Starting January 1, 2026, the bill would require qualified clinical decision support mechanisms to transmit more information to the Secretary of Health and Human Services, and it would shift the reporting framework away from a claim-based certification model toward a mechanism-based reporting model. It also updates terminology and procedures for identifying ordering professionals who do not meet compliance expectations.
The bill creates a new “low compliant” designation for ordering professionals whose rate of consulting a qualified clinical decision support mechanism falls below a threshold set by the Secretary. It directs the Secretary to calculate compliance rates using data from those decision support tools, excluding certain excepted orders, and to report annually on low-compliance patterns. The Secretary would also be required to study the program by January 1, 2031, and every five years thereafter, including the effects on imaging utilization and possible policy responses such as prior authorization or payment adjustments. The bill further requires specialty society endorsement to substantially follow existing federal regulatory practice and exempts certain imaging services, including mammography, lung cancer screening CT, colonography, clinical-trial-related imaging, and some services for small or rural practices.
In practical terms, the bill would amend Section 1834(q) of the Social Security Act and affect Medicare payment and reporting rules for physicians and other ordering professionals who request imaging services. It would also give the Secretary broader authority to specify reporting formats, applicable payment systems, and additional information to be collected from decision support mechanisms. The effective date for the changes is January 1, 2026.
Overall sentiment appears neutral to favorable based on the bill’s bipartisan sponsorship by Senators Blackburn and Cortez Masto and the absence of recorded opposition, votes, or committee debate in the provided materials. The structure of the bill suggests an effort to modernize and streamline imaging-order data collection while preserving exemptions for preventive screening and smaller or rural practices. No specific points of contention are documented in the available record, but the most likely areas of debate would be the expanded reporting burden, the new low-compliance designation, and the possibility of future prior authorization or payment penalties for ordering professionals with lower compliance rates.
The bill would amend Medicare’s imaging-appropriateness provisions in Section 1834(q) of the Social Security Act, changing how ordering professionals and decision support mechanisms report data to CMS and how compliance is measured. It would create new reporting obligations for qualified clinical decision support mechanisms, require ordering professionals’ NPIs on claims in certain cases, establish a low-compliance framework, and direct the Secretary to study and report on utilization and compliance over time. It also creates statutory exemptions for specified screening and preventive imaging services and gives the Secretary authority to identify additional exempt services and applicable payment systems.
The available record suggests generally favorable or at least noncontroversial sentiment. The bill is bipartisan, introduced by Senators Blackburn and Cortez Masto, and there are no recorded committee transcripts, amendments, or votes showing opposition. The absence of documented debate makes it difficult to identify strong support or criticism, but the bill’s design indicates an attempt to improve Medicare imaging oversight without broadly restricting access to screening services.
No explicit contention is documented in the provided materials. Potential areas of concern, based on the text, include whether the new data reporting requirements will increase administrative burden for clinicians and vendors, whether the low-compliance designation could lead to future payment cuts or prior authorization, and how the Secretary will set compliance thresholds and reporting standards. Small and rural practices are specifically protected by an exemption, suggesting lawmakers anticipated concern that the policy could otherwise disproportionately affect those providers.