Italy has changed out half its lineup from the one that lost 25-16 to Canada last Friday.
This weekend's lineup is the same as the one that lost 37-22 to Argentina a week before.
Prop Alberto De Marchi returns after being held out due to a shoulder injury, while hooker Carlo Festuccia (53 caps) and flanker Mauro Bergamasco (91 caps) also come back.
In the backs, the halfback combo of Edoardo Gori and Riccardo Bocchino reprise their partnership from the 2011 Rugby World Cup. Luca Morisi makes his first start for Italy in the centers, and he partners with with Roberto Quartaroli.
Veteran fullback Luke McLean, who missed the first two matches on this tour due to an injured hamstring, is back.
Italy lineup to face USA: 15. Luke McLean, 14. Giovanbattista Venditti, 13. Roberto Quartaroli, 12. Luca Morisi, 11. Tommaso Benvenuti, 10. Riccardo Bocchino, 9. Edoardo Gori, 8. Robert Barbieri, 7. Mauro Bergamasco, 6. Alessandro Zanni, 5. Joshua Furno, 4. Antonio Pavanello, 3. Martin Castrogiovanni (captain), 2. Carlo Festuccia, 1. Alberto De Marchi
Reserves: Davide Giazzon, Michele Rizzo, Simone Favaro, Tommaso D'Apice, Tito Tebaldi, Kris Burton, Alberto Sgarbi.