ROOT Act reopens fight over imaging AUC mandate

The American College of Radiology and the American Society of Nuclear Cardiology are taking opposing positions on the Radiology Outpatient Ordering Transmission Act, or ROOT Act, a bill that would alter Medicare appropriate-use criteria reporting for advanced imaging orders. ACR is urging passage, while ASNC is asking members to oppose the measure.

ACR CEO Dana H. Smetherman, MD, MPH, MBA, testified before the U.S. House Energy and Commerce Subcommittee on Health on May 20 and supported H.R. 5737/S.1692 as a way to modernize the stalled AUC program. Her written testimony said the Moran Company estimated that the program, with ROOT Act changes, would save the federal government about $2B over 10 years and Medicare beneficiaries about $1.5B over the same period.

ACR said the changes would “increase ordering accuracy” and reduce duplicative imaging, unnecessary radiation exposure, and costs. The college also said the bill had been included in a recent Medicare Payment/MACRA reform discussion draft.

ASNC said the proposal would require most clinicians ordering advanced diagnostic imaging to consult AUC through a CMS-approved clinical decision support tool. The society argued that not all approved tools would include criteria developed by cardiovascular medical societies, which it described as the relevant standard for cardiac imaging test selection.

The nuclear cardiology group said AUC consultation is preferable to prior authorization, but opposed adding a Medicare fee-for-service reporting mandate. ASNC said the bill would add “more costs, more time” and more documentation steps for clinicians.

Congress.gov lists the House version, H.R. 5737, as introduced by Rep. Diana Harshbarger on October 10, 2025, and referred to the House Energy and Commerce and Ways and Means committees. The Senate version, S.1692, was introduced by Sen. Marsha Blackburn on May 8, 2025, and referred to the Senate Finance Committee.

The bill text would amend Title XVIII of the Social Security Act to modify data collection requirements for AUC for applicable imaging services. It would require qualified clinical decision support mechanisms to maintain and report certain AUC information to CMS and would direct CMS to calculate compliance rates for ordering professionals.

Proposed exceptions include imaging ordered as part of a clinical trial, orders from small or rural practices, mammography, CT lung cancer screening, CT colonography, and other preventive or screening imaging services determined by the HHS secretary.

CMS paused AUC program implementation on January 1, 2024, and rescinded the related regulations at 42 CFR 414.94. The agency’s AUC page lists CT, PET, nuclear medicine, and MRI as examples of advanced imaging services covered under the original PAMA-authorized program.