SIR enters ROOT Act debate on imaging AUC

The Society of Interventional Radiology has joined the American College of Radiology in supporting the Radiology Outpatient Ordering Transmission Act, or ROOT Act. SIR said on May 28 that the bill would require CMS to implement a program for physicians ordering advanced diagnostic imaging services to consult appropriate use criteria.

The legislation is listed as S.1692 in the Senate and H.R.5737 in the House. Congress.gov lists the House version as introduced on October 10, 2025, and the Senate version as introduced on May 8, 2025.

SIR framed the AUC program as a physician-guideline-based way to reduce low-value advanced imaging. The society said the consultation requirement would not apply to ordering providers participating in clinical trials or to small and rural practices as defined by CMS. Screening imaging services would also be exempt.

The society cited CMS data estimating that the ROOT Act could save Medicare up to $700M each year by reducing low-value advanced diagnostic imaging services. SIR said those savings could help offset long-term Medicare physician-payment reform.

CMS paused implementation of the Medicare AUC program on January 1, 2024, and rescinded regulations at 42 CFR 414.94 while reevaluating the program. CMS lists CT, PET, nuclear medicine, and MRI as examples of advanced imaging services covered by the original PAMA-authorized program.

ACR CEO Dana H. Smetherman, MD, MPH, MBA, testified before the House Energy and Commerce Subcommittee on Health on May 20 and urged passage of the ROOT Act. ACR said the legislation would modernize the AUC program and address rising imaging volume and workforce strain.

ACR cited separate estimates that the ROOT Act would save the Medicare program about $2B over 10 years and save Medicare beneficiaries about $1.5B over the same period.

Support is not uniform across imaging-related specialties. The American Society of Nuclear Cardiology has urged opposition to the bill, saying not all CMS-approved clinical decision support tools would include AUC developed by cardiovascular medical societies for cardiac imaging.

ASNC also argued that AUC consultation should be incorporated into broader quality-improvement and value-based-payment models rather than imposed as a Medicare fee-for-service reporting mandate. The society said the bill would add more administrative steps for clinicians.