Sponsors (2)
The bill aims to reduce low-value imaging and improve program oversight for Medicare (benefiting patient safety and program integrity) but does so by adding reporting, data-sharing, and compliance requirements that raise privacy risks, administrative burdens, and potential costs or penalties for providers.
Medicare beneficiaries may receive fewer unnecessary advanced imaging tests because AUC reporting and compliance monitoring aim to increase appropriate use.
Ordering professionals must include NPIs on Medicare imaging claims, improving billing accuracy and helping care coordination among providers.
Exemptions for small/rural practices and for certain screening services reduce administrative burden for clinicians serving underserved areas and for preventive care.
Patients (especially Medicare beneficiaries and those with chronic conditions) face increased privacy and data-security risks because the bill increases data reporting to HHS/CMS unless safeguards are specified.
Ordering professionals (clinicians) will face new administrative compliance requirements and monitoring that increase paperwork and time spent per patient.
Qualified CDSM vendors must supply data to HHS, which could raise costs for vendors and indirectly increase costs or require system modifications for providers.
Based on analysis of 2 sections of legislative text.
Requires qualified CDSMs to send AUC decision and utilization data to HHS, updates compliance rules and exemptions, and requires ordering NPIs on Medicare imaging claims starting Jan 1, 2026.
Introduced October 10, 2025 by Diana Harshbarger · Last progress October 10, 2025
Requires clinical decision support systems (CDSMs) used for certain outpatient imaging to send appropriate use criteria (AUC) decision and utilization data to the Secretary of HHS beginning January 1, 2026; updates who must comply and how compliance is reported; creates new exemptions for some trials, small/rural practices, and specified screening services; and requires the imaging provider to include the ordering clinician’s NPI on Medicare claims. Directs HHS to issue guidance/rulemaking on reporting, to follow an existing regulatory approach when specifying AUC/CDSM standards, and to deliver periodic studies and reports to Congress on compliance and utilization starting January 1, 2031 and every five years thereafter.