The American Medical Association’s (AMA) Relative Value Scale (RVS) Update Committee (RUC) and Current Procedural Terminology (CPT) Committee currently meet three times a year each to keep the CPT code set up to date, and to review the valuation of all the codes for the physician fee schedule. The two-step meetings of both the CPT Editorial Panel and the RUC allow physicians to provide direct input to the Centers for Medicare & Medicaid Services (CMS), to help meet the challenges of physician reimbursement and provide updates on medical procedures and devices.
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Several ACR volunteers and staff members attend these meetings to provide a voice for rheumatology. At recent meetings, the RUC and CPT Committee finalized recommendations for relative value and editorial changes to codes that could have an impact on the specialty at large.
RUC Meeting Highlights
At the April 2019 meeting in Chicago, the ACR, along with 50 other specialty societies, convened a consensus panel to present the survey results of the evaluation and management (E/M) code sets for office visits 99201–99215. Earlier this year, in an effort to support burden reduction and ensure appropriate valuation, the E/M CPT/RUC Workgroup created a coding structure for 10 new and revised office visit codes. These codes were also created in response to the CMS’ Final Rule of the CY 2019 physician payment schedule.
The joint survey consisted of over 1,700 respondents for each code from primary care, surgery and medicine, areas that represent 95% of Medicare claims for office visits. This was a huge undertaking; the ACR advisors and staff were involved in various aspects of the survey, data analysis and RUC presentations. The survey results and comparison of applicable codes supported favorable recommended values, which were presented to the RUC panel.
Also, in the CY 2019 Final Rule, the CMS stated that they would consider any changes made to the E/M office visits for both coding and valuation. The ACR and all the national medical societies appreciate this effort and look forward to their response to the survey results. The RUC recommendations from the April 2019 meeting are now being finalized and will be sent over to the CMS for review. If approved, any change in valuation will be part of the CY 2021 physician fee schedule.
CPT Meeting Highlights
ACR advisors and staff also attended the May 9–11 CPT meeting in Chicago, providing reviews of and comments on multiple code-change applications, which were presented and voted on during the meeting. All applications will soon be finalized and sent to the AMA Board of Trustees for review and approval.
The RUC and CPT processes take developing treatments in medicine and translate them into a language that allows insurers to pay for given services. The College’s involvement in CPT and RUC activities has taken on greater intensity and importance since the shift in healthcare changes related to procedural codes and valuation. The ACR appreciates members who have participated in physician surveys and encourages others to help further our professional goals through participation if called on for future surveys. The expertise of ACR members and advisors is crucial to the relative value process.
Want More Info?
For questions or additional information on the CPT and RUC process, contact ACR staff liaison Antanya Chung or call (404) 633-3777.