NASHVILLE, Tenn. – U.S. Senators Marsha Blackburn (R-Tenn.) and Catherine Cortez Masto (D-Nev.) introduced the bipartisan Radiology Outpatient Ordering Transmission (ROOT) Act to modernize Medicare’s imaging oversight process. This legislation would remove a key barrier that has delayed implementation of Medicare’s Appropriate Use Criteria (AUC) program, an evidence-based tool that helps ensure only necessary advanced imaging services are ordered for patients. Centers for Medicare & Medicaid Services (CMS) has projected full implementation of AUC will save American taxpayers $700 million in savings each year.

“For years, a flawed reporting mandate has kept a commonsense Medicare cost-saving program from being fully implemented,” said Senator Blackburn. “The ROOT Act would remove that roadblock by eliminating the real-time claims reporting requirement, instead requiring providers to attest to reviewing AUC at point of care. Getting this legislation across the finish line is projected to save American taxpayers millions of dollars each year while realizing the full benefits of the AUC program.”

“When the right imaging is used at the right time, it can lead to better health outcomes and reduce costs for patients and the health care system,” said Senator Cortez Masto. “This commonsense, bipartisan legislation supports evidence-based care and reduces unnecessary scans, saving Medicare billions of dollars while ensuring safer, more personalized care.”

BACKGROUND

• The Protecting Access to Medicare Act (PAMA) established the AUC program to ensure appropriate ordering of advancing diagnostic imaging.

• The AUC program was designed to guide clinicians in real-time selection of diagnostic imaging services and reduce unnecessary imaging costs.

• Full implementation of AUC was supposed to have happened on January 1, 2017, but CMS has been unable to fully launch the program due to challenges incorporating AUC with existing systems.

• Evidence shows the AUC program improves imaging decisions, reduces unnecessary utilization, and cuts costs for both Medicare and its beneficiaries.

• Data from CareSelect Imaging revealed $178 million in inappropriate allowed charges in 2023 could have been avoided with AUC consultation.

RADIOLOGY OUTPATIENT ORDERING TRANSMISSION (ROOT) ACT

• The ROOT Act would remove real-time claims reporting, the primary barrier to the implementation of the AUC program. Instead, this legislation would require providers to attest that they reviewed AUC at the point of care. CMS would conduct retrospective audits based on this data to ensure compliance and inform provider education. An additional carveout reduces administrative burden, exempting those participating in clinical trials and those in small rural practices. 

• The ROOT Act could save American taxpayers billions of dollars:

• $2.2 billion reduction in federal spending from Fiscal Year (FY) 2025 – FY 2034.

• $1.6 billion in savings for Medicare beneficiaries from reduced cost-sharing over the same period.

ENDORSEMENTS

This legislation is supported by the Tennessee Radiological Society, American College of Radiology, and the American Society of Emergency Radiology.

“The real-time AUC program provides enhanced diagnostic accuracy, reduces delays in access and improves outcomes by guiding medical providers to choose the best imaging exam for a patient’s condition or when no scan may be necessary,” said Tennessee Radiological Society President Wesley A. Angel, MD.

“Without taking decisions out of doctor’s hands or delaying care, AUC-based clinical decision support reduces unwarranted imaging, radiation exposure and costs – up to $700 million annually – while ensuring that patients get the right scan for their condition. We look forward to working with Sen. Blackburn and other members of Congress to move the ROOT Act forward,” said American College of Radiology Board of Chancellors Chair Alan Matsumoto, MD, FACR.

“The quality-based AUC ordering approach is good for patients, providers, and taxpayers. The ACR urges health systems, hospitals and practices to build on their CDS investment, and for Congress and CMS to continue to work with medical associations, providers groups and other stakeholders to implement the federal AUC program,” said America College of Radiology CEO Dana Smetherman, MD, FACR.

Click here for bill text.