Medicare hands imaging compliance data to software vendors, exempts rural doctors

What it does

This bill modifies Medicare's rules for imaging services (like CT scans and X-rays) by shifting data collection from individual ordering doctors to clinical decision-support software vendors. Starting January 1, 2026, vendors must report compliance data to the Secretary of Health and Human Services instead of certifying compliance to each ordering doctor. The bill exempts small practices (≤15 doctors), rural practices, clinical trials, and preventive screenings (mammography, lung cancer screening, colonography) from the consultation requirement, and requires the Secretary to study and report on compliance rates and potential enforcement mechanisms like prior authorization or payment adjustments.

Why we flagged it

The bill ostensibly modernizes data collection for imaging appropriateness but functionally transfers compliance-reporting authority from ordering professionals to clinical decision-support software vendors, granting those vendors a gatekeeping role in Medicare data flows while exempting large categories of providers from scrutiny.

What the text implies

• Vendors of clinical decision-support software gain exclusive access to Medicare compliance data and become the primary data source for Secretary enforcement decisions, creating a private intermediary with significant regulatory influence over imaging utilization.
• The exemption for 'small practices (≤15 ordering professionals)' and rural health professional shortage areas removes a large segment of primary-care and rural imaging orders from compliance tracking, potentially creating a two-tier system where urban/large-practice doctors face scrutiny while rural/small practices operate without equivalent oversight.
• Secretary's discretion to designate 'low compliant' ordering professionals and study 'prior authorization' and 'payment adjustments' as enforcement mechanisms is unconstrained by statutory thresholds, creating risk of retroactive or arbitrary enforcement against doctors based on vendor-reported data.
• The bill requires specialty society endorsement of appropriate-use criteria (referencing 42 CFR 414.94) but does not specify which societies or how conflicts of interest are managed, potentially allowing specialty societies with financial stakes in imaging volume to define compliance standards.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Patients may benefit from exemptions for preventive screenings and reduced burden on small/rural practices, improving access to imaging in underserved areas. However, the shift to vendor-based reporting and Secretary's broad discretion to designate 'low compliant' doctors and impose enforcement mechanisms (prior authorization, payment adjustments) creates opacity in how compliance is measured and enforced, potentially delaying necessary imaging for patients whose doctors are flagged as non-compl

Who stands to gain

• Clinical decision-support software vendors
• Imaging service providers (hospitals, imaging centers) benefiting from exemptions for preventive scr
• Small and rural practices exempted from consultation requirements

Named in the bill

Secretary of Health and Human Services, Medicare (Social Security Act Title XVIII), Qualified clinical decision support mechanisms, Ordering professionals, Furnishing professionals, Small practices (≤15 ordering professionals), Health professional shortage areas, Specialty societies, 42 CFR 414.94

Where it stands

1 cosponsor: 1 Republicans.

• Oct 10, 2025 — Introduced · Congress.gov: “Introduced in House”
• Oct 10, 2025 — Referred to House Committee on Ways and Means and House Committee on Energy and Commerce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

2 lobbying clients named this bill on 3 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $122,500 in lobbying spend. A filing names 6 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 41% of bills with at least one filing.

Diana Harshbarger, the sponsor, reported $727,520 in PAC receipts in the 2026 cycle.

• American College of Radiology Association — $100,000 on 2 filings
• American Society for Nuclear Cardiology — $22,500 on 1 filing

Lobbying Disclosure Act filings through Jul 21, 2026. A filing shows who paid to lobby on a bill it names, not what changed.