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How to Get Your CPT Code Valued

How to Get Your CPT Code Valued

Obtaining CPT Code Relative Value Units:

Immediately following the Editorial Panel’s acceptance of the new code proposal, the RUC process begins.  All RUC Advisors have an opportunity to indicate a “level of interest” in developing relative value recommendations for the new code. All societies have 3 options:

  • Survey their members to obtain data on the amount of work involved in the services and develop recommendations;
  • Comment in writing on recommendations developed by other societies;
  • 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; take no action because the codes are not used by physicians in their specialty.

If the Academy is a primary requester of the code, a survey must be conducted. If other specialty societies have an interest in developing recommendations, the survey process must be coordinated by Academy staff so that one relative value recommendation, based on survey data and consensus opinion, can be presented to the RUC. If the Academy supports the code but is not a primary driver, comments only may be submitted.

If an Academy survey is required, the formal RUC survey will be distributed by Academy staff to physician members with knowledge of the procedure. The larger the number of responses to the survey, the more statistically valid the results will be. However the RUC requires a minimum sample size of 30.  

The information gathered about each code includes the respondent's estimate of the appropriate work relative value, the intraservice or intraoperative time involved in the procedure, the number of hospital and office visits typically provided following the procedure, and ratings of the complexity of judgment and technical skill involved in the procedure relative to similar services. The survey data may be augmented by analysis of Medicare claims data and information from other studies of the procedure, such as the Harvard RBRVS study.

After the survey is completed and data analyzed by Academy staff, results will be reviewed by the Physician Payment Policy workgroup. The appropriate survey forms will be submitted to the AMA by Academy staff. 

The requestor of the new code will be notified of the RUC meeting date where the survey results will be presented.  The presentation to the RUC is made by the Academy’s RUC Advisor and the requester or their designated representative.

The CPT and RUC processes are complex and require extensive coordination between interested parties and other medical specialties. It is critical that anyone interested in making changes to the CPT code set, or changes to the Relative Value Units assigned to a code work with Academy leadership and staff to ensure the proper procedures are followed and that Academy support can be provided. 

Should these processes not be followed, the Academy, in accordance with existing policy, reserves the right to withhold support for the request, and, if the request is detrimental to the specialty as a whole, take concerted steps to alter or withdraw it from consideration.