The Relative-Value Scale Update Committee (RUC) is a multispecialty committee within the AMA tasked with advising the Centers for Medicare & Medicaid Services on the valuation of medical services defined by current procedural terminology (CPT) codes. Established in 1992 alongside Medicare’s shift to the Resource-Based Relative Value Scale for Part B reimbursement, the RUC’s recommendations directly influence payments to health care providers. Meeting 3 times annually, the RUC evaluates and proposes valuation for new and revised CPT codes along with providing new valuation recommendations for existing CPT codes that were screened as potentially misvalued. This process integrates insights from over 100 medical specialties. These specialty societies play a pivotal role in the process by surveying members who administer the services under review, and then presenting the findings of these surveys to the RUC for consideration for appropriate valuation. Without such provider input, accurate and fair valuation of procedures would be challenging to achieve.

When a specialty’s services undergo review, specialty societies distribute a RUC survey to a random subset of their members, seeking assistance. The survey covers the code under evaluation and may encompass related CPT codes within the same category slated for evaluation to ensure consistency. Given that not all society members receive surveys, active participation from those who do is crucial to the integrity of the process.

In terms of reimbursement, completing an RUC survey likely represents the most significant influence an individual provider can exert on their specialty (and organized medicine) as a whole.

The process of completing a survey entails the following steps:

• Access the survey link provided. If the survey pertains to a procedure or service you have personally performed within the last 5 years, it is suitable to complete the survey. If the surveyed code does not correspond to a procedure you have performed recently or do not personally perform, you may notify the society to redirect the survey to other randomly selected members. Note that sharing the link and survey directly with others is not permissible. Please be aware that the survey might encompass additional assessments of similar (the “family”) codes if they are also deemed necessary for re-evaluation. At times, evaluating such related codes is crucial to the RUC process.
• Begin filling out the survey. The survey commonly commences with the respondent’s contact information. This typically includes professional details and involves standard questions aimed at ensuring the accuracy of the submitted information and deterring the submission of fraudulent data.
• Thoroughly review the description and vignette of the new or revised procedural code without making any assumptions about its meaning. This is important because one needs to recognize that the new or revised code may entail more or less work compared to familiar codes. When queried about time, estimate based on the specifics outlined in the survey. It’s crucial to account for all the “skin to skin” work involved in the procedure when furnishing the requested time data. Remember, time should exclude services rendered by technicians or other services on the same day that are eligible for separate coding.
• Provide the requested information regarding the duration of time, mental effort and judgment, technical skill and physical effort, and psychological stress experienced during the procedure under evaluation. It’s essential to consider a “typical” patient undergoing a “typical” procedure; one should avoid evaluating the procedure based on extremes such as the easiest or hardest, fastest or slowest, or least or most complicated procedure.
• Compare the relative time and value of the surveyed code to a reference code provided. You’ll be presented with a list of existing procedures for comparison, which may include CPT codes for services performed by other specialties. Select a procedure from the list that you deem most similar in terms of time, complexity, mental effort and judgment, technical skill or physical effort, and psychological stress, then compare it to the surveyed code. Remember, the reference procedure and the surveyed procedure don’t need to have equal work; rather, assess their relative complexity. Some aspects of the surveyed code may be higher, lower, or equal to the reference code. Utilize your clinical judgment for the comparison.
• Estimate the work relative value unit according to the instructions provided within the survey.

Few actions by an individual provider carry as much potential impact for their specialty and organized medicine as conscientiously and accurately completing a RUC survey. It is important for all urologists to play their role, if called upon, in advocating for appropriate reimbursement for urological procedures.