Available online 15 September 2025, 101134

Author links open overlay panel, Abstract

American healthcare policy requires a standard nomenclature(CPT) and valuation process(RUC). We review the makeup of both the CPT panel and advisory panel as well as the processes to create new CPT codes and edit current CPT codes as medical care and technology changes. We describe the RUC panel composition and the processes for determining the valuation of these new or edited CPT codes.

Section snippetsBackground

Prior to 1992, “usual, customary and reasonable” (UCR) were the methods that physicians and hospitals charged for their services and were reimbursed by insurance companies. They were typically accepted on the basis that it fell within the price range of other physicians’ services in the same geographic area and that the service was medically necessary. However, there were concerns that this system of UCR was inequitable and disproportionately favored proceduralists over cognitive specialties

Common procedural technology (CPT®)

Common Procedural Technology (CPT®) are descriptive terms and identifying codes for reporting medical services and procedures performed by physicians and other healthcare providers.3 CPT codes offer a uniform and accepted language that allows for an accurate description of all medical, surgical, and diagnostic services. This terminology is accepted by the medical community to communicate accurately with healthcare providers, insurers, and other third parties.

CPT codes are used for claims

Relative value system update committee (RUC)

The RUC is an AMA committee of volunteer physicians comprised of thirty-two voting members, twenty-two of whom are appointed by their medical specialty societies.5 Similar to the CPT panel, there are seats for the RUC Chair, AMA, CPT Panel, Practice Expense Subcommittee, and HCPAC. The RUC meets three times per year and is aligned to the CPT Panel meetings and CMS’ schedule for updating the Medicare fee schedule in the Federal Register. Similar to the CPT Panel, there is an RUC Advisory

Medicare physician fee schedule

The Medicare Physician Fee Schedule (MPFS) is an annual listing by CMS that outlines payment rates for services provided by healthcare professionals.7 This schedule is often used by other payors such as commercial insurers and Medicaid as a benchmark to help determine the rates that they may reimburse their providers for the same services. Commercial payors often reimburse at rates higher than the Medicare Physician Fee Schedule, typically by a certain percentage, while Medicaid generally

Disclosure

The authors report no conflicts of interest. (AUTHOR CONFIRM COMPLETE AND CORRECT).

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