ACR Urges U.S. House to Pass Radiology Outpatient Ordering Transmission Act

Oct. 10, 2025 — The American College of Radiology (ACR) called on U.S. House members to pass the Radiology Outpatient Ordering Transmission (ROOT) Act (bill number yet to be assigned) introduced today to revitalize the Medicare Imaging Appropriate Use Criteria (AUC) program. The bill would help ensure that seniors receive the most appropriate imaging for their condition, reduce unnecessary radiation exposure and lower Medicare spending on low-value scans.

Introduced in the House by bill sponsor Rep. Diana Harshbarger (R-TN) and cosponsor Rep. Blake Moore (R-UT), the ROOT Act would amend the Protecting Access to Medicare Act (PAMA) of 2014 to ease AUC implementation requirements. Chief among these - that providers consult physician-developed AUC before ordering advanced diagnostic imaging for Medicare beneficiaries.

The ROOT Act previously was introduced in the U.S. Senate (S.1692) by Sens. Marsha Blackburn (R-TN) and Catherine Cortez Masto (D-NV)

Although Congress directed the AUC program to begin in 2017, regulatory delays and a 2023 indefinite pause by the Centers for Medicare and Medicaid Services (CMS) stalled progress — despite CMS acknowledging the program’s potential to save more than $700 million annually.

The ROOT Act proposes several technical changes to PAMA to ensure timely and efficient implementation of the AUC program:

• Simplified Compliance: Replaces the “real-time” claims processing requirement with a provider attestation of AUC consultation.
• Data-Driven Oversight: Compliance data would be collected and reviewed by hospitals and health systems to educate providers and manage utilization.
• Expanded Exemptions: Adds exclusions for providers participating in clinical trials and for small or rural practices, as defined by CMS.
• Program Evaluation: Establishes a review study based on collected data to inform future improvements.

AUC-based clinical decision support systems allow providers to access and consult AUC at the point of care without delaying treatment or interfering with clinical judgment. Providers are not required to follow AUC recommendations, only to demonstrate consultation.

Without ROOT Act passage, the benefits of the AUC program—including improved patient safety, more personalized care and substantial Medicare savings—will remain unrealized.

For more information on the American College of Radiology (ACR), go to www.acr.org.