In June 2025, the Centers for Medicare & Medicaid Services (CMS) officially implemented a new CT quality measure: CMS1074v2, which focuses on radiation dose and image quality metrics. The rule affects all healthcare providers performing computed tomography (CT) exams and is designed to enhance patient safety while addressing inconsistencies in dose reporting across facilities.

This marks a notable evolution in how CT imaging quality is tracked and reported under CMS’s Quality Payment Program, reinforcing the agency’s continued emphasis on value-based care and precision in diagnostic imaging.

What Is CMS1074v2?

CMS1074v2 centers around the calculation and monitoring of Size-Adjusted Dose (SAD) during CT scans. The measure requires providers to calculate a size-adjusted dose for each CT exam using effective diameter, then evaluate those values against accepted benchmarks for different anatomical regions (thorax, abdomen, pelvis, etc.).

This measure doesn’t just focus on radiation exposure — it links dose appropriateness with image quality, requiring radiology teams to balance diagnostic clarity and patient safety.

According to CMS, the goal is to encourage facilities to reduce unnecessary radiation while ensuring CT scans still meet clinical utility standards .

Why Is This a Big Deal for Radiology?

The challenge in radiology has long been striking a balance between diagnostic quality and dose minimization. Prior to CMS1074v2, there was no universal requirement for how facilities calculated size-adjusted dose, leading to large variability in methods and outcomes.

A March 2025 study published on arXiv found that five widely used methods for estimating effective diameter yielded significant differences in SAD calculations, which could directly influence whether a CT scan was categorized as compliant or not (source).

CMS1074v2 aims to reduce that variability by enforcing a consistent approach across providers. While the measure is currently limited to CT scans performed in outpatient settings, it’s expected that similar benchmarks may be expanded into hospital settings in the future.

How Imaging Centers Can Prepare

Implementing CMS1074v2 isn’t just about adding a new line item to reporting tools — it may require substantial changes to imaging workflows, technology, and staff training.

Here are key steps radiology departments should take:

• Standardize Effective Diameter Calculations: Ensure your PACS or scanner software uses consistent measurement protocols.
• Review CT Protocols for Dose Optimization: CT protocols may need to be adjusted to meet benchmark thresholds without compromising image quality.
• Invest in Staff Training: Radiology technologists and supervising physicians must understand how SAD is derived and what values are considered acceptable for each body region.
• Audit Current Practices: Review your historical CT exams to identify whether your dose metrics currently fall within expected parameters.

Potential Impact on Reimbursement and Compliance

CMS1074v2 is part of the Merit-Based Incentive Payment System (MIPS), which affects how radiology providers are scored for quality performance. Noncompliance or poor performance on this measure could reduce reimbursement — especially for those participating in the Quality Payment Program.

However, facilities that demonstrate high compliance may benefit from positive scoring adjustments and recognition for imaging excellence. In other words, meeting this benchmark isn’t just about avoiding penalties — it could position your imaging center as a high-quality provider under CMS metrics.

Bottom Line: A Push Toward Precision and Safety

CMS1074v2 represents a bigger shift in imaging: toward measurable safety, transparency, and data-driven quality assurance. For radiology providers, especially those involved in high-volume CT scanning, this rule presents an opportunity to fine-tune protocols, improve patient outcomes, and strengthen compliance in a competitive healthcare environment.

While implementation requires coordination across teams, IT systems, and scanners, the end result may be safer, more efficient imaging that aligns with the future of value-based care.

The post What CMS1074v2 Means for CT Radiation Dose Monitoring and Radiology Workflows first appeared on Vesta Teleradiology.