ASTRO works in coordination with the American Medical Association’s Current Procedural Terminology (CPT®) Editorial Panel to establish new radiation oncology CPT codes and works with the AMA/Specialty Society Relative Value System Update Committee to assign relative value units to new and already established radiation oncology CPT codes. These are critical functions that allow members to bill properly for services rendered and to receive reimbursement for such services.
Overview of the CPT and RUC Process
The CPT Editorial Panel and the AMA RVS Update Committee (RUC) have a significant impact on Medicare reimbursement for radiation oncologists and other physician providers. ASTRO participates in both processes representing the needs and priorities of radiation oncologists, radiation oncology nurses, medical physicists, radiation therapists, dosimetrists, biologists and the patients they serve.
CPT Editorial Panel
CPT codes are published by the American Medical Association (AMA). The CPT Editorial Panel, comprised of 17 members, is responsible for maintaining, revising, updating or modifying the CPT code set. To establish a new CPT code an individual or specialty society submits a code change proposal to the Panel. If a code is approved it will be published in the CPT book and is also sent to the AMA RUC for valuation. ASTRO’s advisor to the CPT Editorial Panel attends CPT meetings, presents proposals for new radiation oncology codes and reviews and comments on code proposals submitted by other societies and members of the public.
More information about the AMA CPT Editorial Panel can be found on the AMA website.
AMA RVS Update Committee (RUC)
Once the CPT Editorial Panel approves a code proposal the code is then sent to the RUC. The purpose of the RUC process is to provide recommendations to CMS for use in annual updates to the Medicare Physician Fee Schedule (MFS). The RUC is a 29 member committee whose members are appointed by national medical specialty societies.
The specialty society surveys the code to estimate physician work and determine direct practice expense inputs associated with the service. The RUC reviews and votes on all recommendations. ASTRO has an advisor assigned to the RUC who attends RUC meetings and manages the survey process for radiation oncology codes. The RUC then submits the final recommendations to the CMS who considers these recommendations and publishes interim values in the physician fee schedule. Values are considered interim for one year and open to public comment.
The AMA RUC website includes expanded information regarding the RUC process.