The American Medical Association (AMA) Relative Value Update Committee (RUC) and Current Procedural Terminology (CPT) meet three times a year to keep the CPT code set up to date and review resource costs for physicians. The two-step meetings of the CPT Editorial Panel and the RUC allow physicians to provide direct input to the Centers for Medicare & Medicaid Services (CMS), helping meet the changing needs of medicine and speeding up the inclusion of updated medical techniques in the CPT code set.
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The ACR has five volunteer advisors who actively participate in the AMA’s CPT Editorial Panel and RUC processes to ensure CPT codes appropriate for rheumatologic services and procedures are developed and the appropriate values are placed on the codes. The advisors to the CPT Editorial Panel and the RUC frequently work with advisors from other specialty societies to develop and present new and revised CPT code proposals and recommended code values. Below is a guide on the CPT and RUC processes, as well as the ACR’s recent activities in this area.
The Process
The CPT Editorial Panel maintains the CPT code set and meets regularly to review proposals for new and revised codes, while the RUC makes recommendations to the CMS on relative values assigned to all new and revised CPT codes.
Once codes are vetted and voted on at the CPT Editorial Panel, specialty societies then survey their members and make recommendations to the RUC based on their areas of expertise. The RUC requires the most rigorous methodology for these surveys, recently increasing the minimum survey size and establishing a centralized, online data collection process.
ACR Actions
In the first quarter of 2019, the ACR advisors have been very active in reviewing new and revised CPT codes for rheumatology procedures and services based on new technology and changes in practice, as well as responding to requests from the CMS and the AMA. To date, the ACR has been involved with surveying new and revised codes to develop recommended values for presentation at the RUC for X-rays of the sacrum and newly revised evaluation and management (E/M) office visit codes.
The ACR frequently works in conjunction with other related specialty societies on CPT and RUC issues. In January, the ACR worked alongside the American College of Radiology on the diagnostic codes for X-ray of the sacrum (CPT codes 72200 and 72202) and a multiple specialty group for the E/M codes.
For CPT codes 72200 and 72202, the specialties recommended a work RVU of 0.20 for CPT code 72200 and 0.26 for CPT code 72202, which is the 25th percentile survey value, and higher than the original work time. The survey allowed for an increase in cost as a result of the increase in physician time, per the multi-specialty RUC survey. The increase correlates to the increase in professional picture archiving and communication system workstation time in practices.
The multi-specialty survey on physician time and practice expense for the E/M office visit codes results will be reviewed at the April RUC meeting in Chicago. The ACR advisors were very involved and led various aspects of the survey recommendation and review process.
The CPT and RUC processes take developing treatments in medicine and eventually translate them into a language that allows insurers to pay for the service. The College’s involvement in CPT and RUC activities has taken on greater intensity and importance as the healthcare environment has evolved.
Your Expertise Requested
The ACR appreciates members who have already participated in physician surveys and encourages all members to participate in future surveys to help further our professional goals. The expertise of our members and advisors is crucial to the future of rheumatology.
Don’t forget: The ACR can represent rheumatology and bring members’ concerns and issues to the AMA only because ACR members join or renew their membership in the AMA.
For questions or additional information on the CPT and RUC process, contact ACR staff member Antanya Chung at achung@rheumatology.org or 404-633-3777.