Radiology Outpatient Ordering Transmission (ROOT) Act
Sponsored By: Senator Marsha Blackburn
Introduced
Summary
Strengthens Medicare's tracking of imaging orders by shifting reporting duties to qualified clinical decision support mechanisms (QCDSMs) and creating a data-driven compliance program. It would require QCDSMs to submit standardized data to the Secretary starting January 1, 2026 and introduce a 'low compliant' designation based on a compliant-rate metric.
Show full summary
- Ordering professionals and Medicare patients: Could be labeled 'low compliant' if their compliant-rate falls below a Secretary-set threshold. That designation could lead HHS to consider actions that affect imaging use, such as prior authorization or payment changes, after study and reporting.
- Qualified clinical decision support mechanisms (QCDSMs) and claims: QCDSMs would take on new obligations to maintain and report specific data elements to the Secretary in the form and on the schedule HHS specifies beginning January 1, 2026. When imaging is paid under an applicable system, claims must include the ordering professional's national provider identifier.
- Small/rural practices, trials, screening services, and oversight: The bill creates explicit exemptions for clinical trials, certain preventive screenings, and small or rural practices (defined as 15 or fewer ordering professionals or located in a rural health professional shortage area). It would also require a congress-facing study due January 1, 2031 and every 5 years that examines compliance, utilization effects, and potential remedies, and it directs HHS to follow specialty society endorsement approaches when specifying AUC and QCDSMs.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 0 benefits, 1 costs, 1 mixed.
New rules for imaging decision systems
If enacted, this would make clinical decision support systems keep and send detailed data to HHS starting January 1, 2026. The Secretary would use that data to compute each ordering clinician's compliance rate and each year label clinicians as “low compliant” if their rate is below a cutoff the Secretary sets. Certain orders would be excluded, like clinical trial scans, orders from small or rural practices, and specified screening tests. The bill would shift reporting duties to the decision-system vendors and require HHS to give guidance on how they must report.
Put ordering clinician NPI on claims
If enacted, this would require providers to put the ordering clinician's NPI on the Medicare claim for certain outpatient imaging starting January 1, 2026. The rule applies when the ordering clinician is different from the person who furnished the scan and the service is paid under an applicable payment system. This is a billing change that may need small IT or administrative updates by providers.
Sponsors & CoSponsors
Sponsor
Marsha Blackburn
TN • R
Cosponsors
Catherine Cortez Masto
NV • D
Sponsored 5/8/2025
James Risch
ID • R
Sponsored 7/8/2025
Rick Scott
FL • R
Sponsored 7/21/2025
Jacky Rosen
NV • D
Sponsored 7/21/2025
Roll Call Votes
No roll call votes available for this bill.
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