This bill amends Title XVIII of the Social Security Act to significantly modify data collection and compliance requirements for appropriate use criteria (AUC) related to applicable imaging services under Medicare. These changes, effective January 1, 2026, aim to streamline reporting and refine the identification of non-compliant ordering professionals. A core provision requires qualified clinical decision support mechanisms (CDSMs) to directly transmit detailed consultation information to the Secretary, rather than providing certification to the ordering professional. The CDSMs will also be responsible for maintaining and reporting specific data to the Secretary to support program implementation.

The legislation introduces several new exemptions from AUC requirements, broadening the scope of services and practices not subject to these rules. These exemptions include imaging services ordered as part of clinical trials, and those ordered by professionals practicing in small practices (15 or fewer) or in rural health professional shortage areas. Additionally, specific imaging services such as mammography, lung cancer screening computed tomography, and colonography computed tomography are now exempt. Furnishing professionals will also be required to include the ordering professional's National Provider Identifier (NPI) on claims for applicable imaging services.

The bill renames "outlier ordering professionals" to "low compliant ordering professionals" and directs the Secretary to annually determine a compliance rate for each professional. This rate will be based on the proportion of applicable imaging service orders for which a CDSM was consulted, specifically excluding the newly exempted services. Professionals whose compliance rate falls below a Secretary-determined threshold will be designated as "low compliant." Finally, the Act mandates regular studies, beginning in 2031, to assess compliance rates, the program's impact on imaging utilization, and potential mechanisms for improving adherence, such as prior authorization or payment adjustments.