Washington, D.C. – U.S. Senators Catherine Cortez Masto (D-Nev.) and Marsha Blackburn (R-Tenn.) introduced the bipartisan Radiology Outpatient Ordering Transmission (ROOT) Act to modernize Medicare’s imaging oversight process. This legislation would remove a key barrier that has delayed implementation of Medicare’s Appropriate Use Criteria (AUC) program.
“When the right imaging is used at the right time, it can lead to better health outcomes and reduce costs for patients and the health care system,” said Senator Cortez Masto. “This commonsense, bipartisan legislation supports evidence-based care and reduces unnecessary scans, saving Medicare billions of dollars while ensuring safer, more personalized care.”
The Protecting Access to Medicare Act (PAMA) established the AUC program to ensure appropriate ordering of advancing diagnostic imaging. The AUC program was designed to guide clinicians in real-time selection of diagnostic imaging services and reduce unnecessary imaging costs. Full implementation of AUC was supposed to have happened on January 1, 2017, but CMS has been unable to fully launch the program due to challenges incorporating AUC with existing systems. Evidence shows the AUC program improves imaging decisions, reduces unnecessary utilization, and cuts costs for both Medicare and its beneficiaries. Data from CareSelect Imaging revealed $178 million in inappropriate allowed charges in 2023 could have been avoided with AUC consultation.
The ROOT Actwould remove real-time claims reporting, the primary barrier to the implementation of the AUC program. Instead, this legislation would require providers to attest that they reviewed AUC at the point of care. CMS would conduct retrospective audits based on this data to ensure compliance and inform provider education. An additional carveout reduces administrative burden, exempting those participating in clinical trials and those in small rural practices.
The ROOT Act could save American taxpayers billions of dollars:
- $2.2 billion reduction in federal spending from Fiscal Year (FY) 2025 – FY 2034.
- $1.6 billion in savings for Medicare beneficiaries from reduced cost-sharing over the same period.
The full text of the legislation can be found here.
Senator Cortez Masto has been a champion of affordable, quality health care, including mental and behavioral care. Cortez Masto has pushed pharmacy benefit managers to help lower prescription drug costs. She passed legislation to allow Medicare to negotiate lower drug prices and cap the cost of insulin at $35-a-month for Medicare recipients through the Inflation Reduction Act. To lower health care costs for all Nevadans, Cortez Masto worked to expand health care subsidies for individuals and families getting health care through the exchange. She recently introduced bipartisan legislation to provide patients with transparent and timely access to prescription medications and treatments.
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