I 
119TH CONGRESS 
1ST SESSION H. R. 5737 
To amend title XVIII of the Social Security Act to modify data collection 
requirements for appropriate use criteria for applicable imaging services, 
and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
OCTOBER 10, 2025 
Mrs. HARSHBARGER (for herself and Mr. MOORE of Utah) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend title XVIII of the Social Security Act to modify 
data collection requirements for appropriate use criteria 
for applicable imaging services, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Radiology Outpatient 
Ordering Transmission Act’’ or the ‘‘ROOT Act’’. 
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SEC. 2. MODIFICATION OF APPROPRIATE USE CRITERIA 
DATA COLLECTION FOR APPLICABLE IMAG-
ING SERVICES. 
(a) IN GENERAL.—Section 1834(q) of the Social Se-
curity Act (42 U.S.C. 1395m(q)) is amended— 
(1) in paragraph (3)(B)(ii)— 
(A) in subclause (IV), by striking ‘‘gen-
erates and provides to the ordering professional 
a certification or documentation that’’; and 
(B) by adding at the end the following new 
subclause: 
‘‘(VIII) Beginning January 1, 
2026, the mechanism provides to the 
Secretary— 
‘‘(aa) the information de-
scribed in subclauses (III) and 
(IV); 
‘‘(bb) the information de-
scribed in paragraph (4)(B); and 
‘‘(cc) such other information 
as the Secretary determines to be 
appropriate, at such time, and in 
such form and manner, as the 
Secretary may specify.’’; 
(2) in paragraph (4)— 
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(C) in subparagraph (C), by adding at the 
end the following new clauses: 
‘‘(iv) CLINICAL TRIALS.—An applica-
ble imaging service that is ordered for an 
individual as part of a clinical trial. 
‘‘(v) 
SMALL
AND
RURAL
PRAC-
TICES.—An applicable imaging service or-
dered by an ordering professional prac-
ticing in a small practice (consisting of 15 
or fewer ordering professionals), or a prac-
tice in a health professional shortage area 
(as designated under section 332(a)(1)(A) 
of the Public Health Service Act) located 
in a rural area. 
‘‘(vi) SPECIFIED
EXEMPTIONS.—The 
following types of applicable imaging serv-
ices: 
‘‘(I) A mammography. 
‘‘(II) A lung cancer screening 
performed using computed tomog-
raphy. 
‘‘(III) A colonography performed 
using computed tomography. 
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‘‘(IV) Such other preventive or 
screening imaging services as the Sec-
retary determines appropriate.’’; 
(D) in subparagraph (D), by adding at the 
end the following new clause: 
‘‘(iv) Any other payment system de-
termined appropriate by the Secretary.’’; 
and 
(E) by adding at the end the following new 
subparagraphs: 
‘‘(E) 
FURNISHING
PROFESSIONAL
RE-
QUIREMENT.—Beginning January 1, 2026, with 
respect to an applicable imaging service fur-
nished in an applicable setting and paid for 
under an applicable payment system (as defined 
in subparagraph (D)), the furnishing profes-
sional shall include the national provider identi-
fier of the ordering professional (if different 
from the furnishing professional) on the claim 
for the service. 
‘‘(F) REPORTING
REQUIREMENTS.—The 
Secretary shall provide, through guidance or 
rulemaking, information on appropriate ways 
that each qualified clinical decision support 
mechanism may report the information main-
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tained under subparagraph (B) to the Secretary 
to support the Secretary in implementing para-
graphs (5) and (6).’’; 
(3) in paragraph (5)— 
(A) in the heading, by striking ‘‘OUTLIER’’ 
and inserting ‘‘LOW COMPLIANT’’; 
(B) by striking subparagraphs (A) and (B) 
and inserting the following: 
‘‘(A) IN GENERAL.—With respect to appli-
cable imaging services furnished on or after 
January 1, 2026, the Secretary shall determine 
on an annual basis the total number of ordering 
professionals who are designated as low compli-
ant ordering professionals under subparagraph 
(B). 
‘‘(B) LOW COMPLIANT ORDERING PROFES-
SIONALS.—The Secretary shall designate order-
ing professionals with a compliance rate (as de-
termined under subparagraph (D)) lower than 
an amount determined by the Secretary as low 
compliant ordering professionals.’’; 
(C) in paragraph (C), by striking ‘‘outlier’’ 
and inserting ‘‘low compliant’’; 
(D) by striking subparagraph (D) and in-
serting the following: 
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‘‘(D) DETERMINATION
OF
COMPLIANCE 
RATE.— 
‘‘(i) IN GENERAL.— 
‘‘(I) COMPLIANCE
RATES.—For 
applicable imaging services furnished 
on or after January 1, 2026, the Sec-
retary shall determine a compliance 
rate (as defined in clause (ii)) for 
each ordering professional for a period 
specified by the Secretary. 
‘‘(II) USE OF DATA.—In deter-
mining a compliance rate for an or-
dering professional under subclause 
(I), the Secretary shall use data made 
available to the Secretary by qualified 
clinical decision support mechanisms 
published in the list under paragraph 
(3)(C) that were consulted by the or-
dering professional for the period 
specified by the Secretary under sub-
clause (I). 
‘‘(ii) DEFINITION
OF
COMPLIANCE 
RATE.— 
‘‘(I) IN GENERAL.—In this sub-
paragraph, the term ‘compliance rate’ 
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means, with respect to the require-
ment that an ordering professional 
consult with a qualified decision sup-
port mechanism when ordering an ap-
plicable imaging service under para-
graph (4)(A)(i), the ratio (expressed 
as a percentage) of— 
‘‘(aa) the number of claims 
for orders for an applicable imag-
ing service from such ordering 
professional during the period 
specified by the Secretary under 
clause (i)(I) that provided the 
qualified decision support mecha-
nism consulted by such ordering 
professional; and 
‘‘(bb) the total number of 
orders for an applicable imaging 
service from such ordering pro-
fessional during such period. 
‘‘(II) EXCLUSION OF EXCEPTED 
ORDERS.—In calculating the compli-
ance rate for an ordering professional 
under subclause (I), the Secretary 
shall exclude from the total number of 
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orders in item (bb) of such subclause 
any order for an applicable imaging 
service 
described 
in 
paragraph 
(4)(C).’’; and 
(E) in subparagraph (E), by striking 
‘‘outlier’’ and inserting ‘‘low compliant’’; 
(4) by striking paragraph (6) and inserting the 
following: 
‘‘(6) STUDY AND REPORT ON LOW COMPLIANT 
ORDERING PROFESSIONALS AND UTILIZATION OF AP-
PLICABLE IMAGING SERVICES.— 
‘‘(A) IN GENERAL.—Not later than Janu-
ary 1, 2031, and every 5 years thereafter, the 
Secretary shall conduct a study regarding the 
compliance rates calculated under paragraph 
(5) and submit a report to Congress that— 
‘‘(i) discusses— 
‘‘(I) such rates and compliance 
with this subsection; 
‘‘(II) the impact this subsection 
has on the utilization of applicable im-
aging services; and 
‘‘(III) potential mechanisms for 
improving compliance with this sub-
section, including— 
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‘‘(aa) prior authorization for 
applicable imaging services or-
dered by low compliant ordering 
professionals; 
‘‘(bb) any payment adjust-
ment related to the services, or a 
subset of services, that the Sec-
retary may designate under the 
fee schedule under section 1848; 
or 
‘‘(cc) other mechanisms de-
termined appropriate by the Sec-
retary; and 
‘‘(ii) proposes alternative compliance 
rate thresholds for low compliant ordering 
professionals for purposes of paragraph 
(5)(B).’’; and 
(5) by adding at the end the following new 
paragraph: 
‘‘(8) SPECIALTY SOCIETY ENDORSEMENT.—In 
specifying applicable appropriate use criteria for ap-
plicable imaging services under paragraph (2) and 
qualified clinical decision support mechanisms under 
paragraph (3), the Secretary shall substantially ad-
here to the approach described in section 414.94 of 
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title 42, Code of Federal Regulations (as in effect on 
January 1, 2023).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on January 1, 2026. 
Æ 
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