S. 1692 — Radiology Outpatient Ordering Transmission (ROOT) Act

This section revises the appropriate use criteria (AUC) program for applicable imaging services (i.e., advanced diagnostic imaging services such as MRI, CT, PET, and nuclear medicine) under Medicare Part B by delaying key requirements to January 1, 2026 (from prior dates including January 1, 2017), shifting reporting obligations from claims to qualified clinical decision support mechanisms (CDSM), and adding exemptions and enforcement changes. Specifically, the section (1) requires CDSMs to report specified data (e.g., ordering professional identifiers, prior authorization information) directly to the Secretary; (2) mandates that furnishing professionals include the ordering professional's national provider identifier on claims; (3) expands exemptions from CDSM consultation to include services ordered for clinical trials, by small practices (15 or fewer professionals) or rural health professional shortage areas, and specified preventive services (e.g., mammography, lung cancer screening CT); (4) redefines "low compliant ordering professionals" based on an annual compliance rate (i.e., percentage of orders consulting a CDSM, excluding excepted orders) below a Secretary-determined threshold, using CDSM-reported data; and (5) replaces prior outlier ordering professional review provisions with a study and report on low compliant professionals and imaging utilization due by January 1 (year unspecified). (Thus, the changes delay mandatory compliance, reduce administrative burden on claims, and limit enforcement to higher-volume practitioners while exempting underserved settings.)