Recent legislative initiatives to restrict (or eliminate) the Stark Law’s In-Office Ancillary Services Exception (IOASE) are by no means a new phenomenon. Rather, over the last few years, the Centers for Medicare and Medicaid Services (CMS) has introduced several significant proposals targeting the provision of diagnostic imaging (and other ancillary services) in the physician office setting, through proposed changes to the Stark regulations, independent diagnostic testing facility (IDTF) regulations, and other Medicare reimbursement regulations (such as the Medicare Anti-Markup Rule [AMR]). Despite these proposals, however, the IOASE remains intact and the prospect of a near-term wholesale elimination of the IOASE appears remote. This article provides a brief overview of the IOASE and examines some recent CMS legislative initiatives directed at diagnostic imaging arrangements. Finally, this article discusses the current status of the IOASE, which permits (and, we expect, will continue to permit) appropriately structured diagnostic imaging arrangements in the physician office setting.