ACR Endorses MARCA Bill for Clarifying Radiologist Assistant Duties and Compensation

The American College of Radiology (ACR) has expressed its support for the Medicare Access to Radiology Care Act (S. 4624), also known as MARCA. This proposed legislation aims to establish clearer protocols for the payment, roles, and scope of practice of radiologist assistants (RAs).

Under the provisions of MARCA, radiologists would receive Medicare payments directly for services in which RAs participate. This adjustment intends to authorize RAs to perform delegated duties under radiologists' supervision in areas that recognize RA practice. The bill further outlines the necessary training and boundaries of practice for RAs.

According to Christoph Wald, MD, PhD, MBA, FACR, chair of the ACR Board of Chancellors, “The RA is very different from other physician extenders in payment, training, and clearly-defined scope of practice.” He noted that MARCA’s passage could enhance the efficiency of radiology services, support physician-led care, and help meet the rising demand for imaging, all while navigating the complexities associated with non-physician practitioners.

The ACR maintains its stance against allowing non-physician providers, including RAs, to supervise or interpret imaging examinations. RAs are specifically trained to support radiologists by handling tasks that permit radiologists to focus on their core functions, such as imaging recommendations and interpretations.

RAs undergo comprehensive education that combines a rigorous academic program with a radiologist-directed clinical preceptorship. Additionally, they must pass a recognized certification exam and engage in ongoing education, making their training in radiology services unparalleled among non-physician practitioners.

Dana H. Smetherman, MD, MPH, MBA, FACR, CEO of ACR, emphasized the specificity of the RA’s role: “Unlike some other non-physician providers, the RA’s scope of practice specifically excludes imaging supervision and interpretation. Under MARCA, RAs are only reimbursed as part of a radiologist-led team - not as independent practitioners.”

The development of the RA role was a collaborative effort among the ACR, the American Society of Radiologic Technologists (ASRT), the Society of Radiology Physician Extenders (SRPE), and the American Registry of Radiologic Technologists (ARRT), all of whom back the MARCA legislation. In 2025, the ACR Council supported the adoption of a new policy to move forward from its previous neutral position regarding RA usage, backing MARCA to ensure appropriate Medicare reimbursement for radiology practices utilizing RAs.