Applying for CPT Codes and Obtaining RVUs for CPT Codes

Applying for CPT Codes and Obtaining RVUs for CPT Codes

*New* Overview of CPT Editorial Review Process

Slides courtesy of Richard Waguespack, MD, FACS, President Elect AAO-HNS, Former CPT Editorial Panelist, CPT Advisor for the Trilogical Society. 

How to Apply for, or revise, a CPT Code - New Technology Pathway

There are specific procedures in place both at the Academy and within the AMA to evaluate recommendations to changes in the Current Procedural Terminology (CPT) code set. The Academy has a dedicated CPT & Relative Value Committee to address these issues. This committee is comprised of experienced physician who have served as Academy representatives to the CPT Editorial Panel and the RVS Updating Committee (RUC) through the Physician Payment Policy Workgroup (aka “3P”). The committee also includes a dedicated staff member to interact with interested stakeholders in the CPT code development and revision process. 

Stakeholders interested in working with the Academy to obtain a new CPT code, or revise an existing CPT code set, should begin by obtaining a copy of the Academy's New Technology Pathway requirements. For more information on the New Technology Pathway process, click the heading above.

How to Obtain Relative Value Units for CPT codes

Immediately following the CPT Editorial Panel’s acceptance of the new code change proposal (CCP), the RUC process begins.  All participating specialties have an opportunity to indicate a “level of interest” from which indicates their interest in developing relative value recommendations for the new code(s). All societies have 4 options:

  1. Survey their members to obtain data on the amount of work involved in the services and develop recommendations;
  2. Comment in writing on recommendations developed by other societies;
  3. In the case of editorially changed/ revised codes, they could decide that the coding change does not require action because it does not significantly alter the nature of the service or the previously assigned relative value; or
  4. Take no action because the codes are not used by physicians in their specialty.

The Academy Needs You! Fill Out a RUC Survey

The Academy needs experts three times a year to fill out RUC surveys for the AMA Specialty Society/ Relative Value Update Committee! The RUC is a joint effort of the American Medical Association and medical specialty societies that makes recommendations on revising and updating the resource-based relative value scale (RBRVS), which is utilized by Medicare and many private payers to determine reimbursement for medical services. Information, such as the time and intensity takes to perform certain services for patients are derived by surveying physicians who have expertise in performing those services. This information is critical to ensuring appropriate valuation.

The Academy strongly encourages members who are familiar with a procedure undergoing a RUC survey to take the time to complete a survey. Filling out a survey takes about 20 minutes. Before completing a survey, please review important background information by viewing the following slide set developed by the AMA RUC, which can be found here. Background on the RUC survey process and instrument can be found in this 2011 August Bulletin article (login required). 

Updated on April 18th, 2013