This bill changes how Medicare tracks and encourages the right use of advanced imaging tests like CT scans. Starting January 1, 2026, doctors who order these tests will need to use approved decision tools more consistently. Medicare will measure each ordering doctor’s “compliance rate” based on how often they consult these tools when they order imaging. Doctors with low compliance may be flagged, and the government will study the results and suggest ways to improve, which could include steps like prior authorization or payment changes in the future. Imaging done as part of clinical trials, certain preventive screenings (like mammograms, CT lung cancer screening, and CT colonography), and orders from small or rural shortage-area practices are excluded from these compliance counts. Medicare will also require the billing provider to include the ordering doctor’s national provider identifier on claims for these services. The systems that provide the decision support will report needed data to Medicare to help run this program, and Medicare will follow existing approaches for using specialty society-endorsed tools.

• A study and report to Congress is due by January 1, 2031, and then every five years, discussing compliance rates, imaging use, and options to boost compliance.

Key points

• Who is affected: Doctors who order Medicare imaging; clinics and hospitals that bill for these tests; Medicare patients getting advanced imaging. Small practices (15 or fewer ordering clinicians) and rural shortage-area practices have exemptions, as do certain screening tests.
• What changes: Use of approved decision tools is tracked and reported; low-compliance ordering may trigger future oversight; claims must include the ordering doctor’s ID; decision tool systems report data to Medicare.
• When: Most changes start January 1, 2026; the first federal report is due by January 1, 2031.