Up to code: What's a RUC survey?

How psychologists’ input helps determine the value of a reimbursement code.

From time to time, the Practice Organization may need your valuable input for appropriate valuation of Current Procedural Terminology (CPT) codes by completing the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) survey.

These surveys are important to psychologists and other healthcare professionals because they help Medicare and other health insurers set reimbursement rates.

The RUC survey is a tool used by AMA to collect objective data on health care services provided by psychologists, physicians and other health care professionals. Data from these surveys is used by AMA to assign a specific relative value unit for the CPT code assigned to each service.

When new CPT codes for new procedures or services are developed and approved by the AMA CPT Editorial Panel, the next step is the valuation of the new code for healthcare professional reimbursement. (See previous Practice Update articles for more on CPT code revisions.)

The RUC survey helps determine relative value units (RVU) for new procedures and their assigned codes. This RVU is multiplied by a set dollar figure (called the conversion factor) to determine the price at which Medicare reimburses practitioners for the procedure.

Once the surveys are completed, the Practice Organization reviews the data and develops recommendations related to the work and practice (business) expenses (i.e. testing software fees or computer purchases) involved with performing the new procedures. The recommendations are presented at an AMA/RUC Meeting. The AMA/RUC determines a value for the new CPT codes and submits confidential work and practice expense recommendations to the Centers for Medicare and Medicaid Services (CMS). CMS makes the final decisions and publishes their approved values for the codes in the Medicare Physician Fee Schedule proposed rule, through the Federal Register. Final CMS-approved values go into effect yearly.

Read on for instructions on how to complete a RUC survey.

Components of a RUC survey

The RUC survey refers to psychologists and other non-physician providers as “qualified healthcare professionals.”

The RUC defines “qualified healthcare professional” work to include:  

  • Qualified healthcare professional’s time it takes to perform the service.
  • Qualified healthcare professional’s mental effort and judgment.
  • Qualified healthcare professional’s technical skill and physical effort.
  • Qualified healthcare professional’s psychological stress that occurs when an adverse outcome has serious consequences.

How survey respondents are selected  

The Practice Organization identifies psychologists and neuropsychologists either through a random sampling of our membership and/or from a random sample of psychologist and neuropsychologist members identified through divisions or state psychological associations. The Practice Organization then emails the RUC survey to this select group of psychologists.

It is important to submit your response by the date provided in the email. The timeliness of your response is critical because the Practice Organization will need to review the data before it can be submitted to the AMA/RUC.

How is the RUC survey completed?      

The survey form can be completed online. You will be able to stop at any time and return to the site to continue the survey and begin where you stopped. You cannot to share your link to the survey with anyone else.

The new codes and procedures being evaluated in the survey have been selected by the AMA/RUC or CMS.

It is critical to read the description of the new procedure code carefully. Do not assume that the described procedure is necessarily the same as another one you have performed.  Do not substitute for other codes you may have used in the past.

Here are the six steps for completing the survey in the most accurate and appropriate way:

  • Step 1: Review code descriptor and patient vignette. The vignette describes the typical patient for the procedure being surveyed. You may have performed the procedure on a patient different than the “typical” one described in the vignette — that’s OK — you can use your experience to guide your responses. If you have performed this procedure within the last year, go ahead and complete the survey. If you have not performed this procedure within the last year, do not complete the survey.
  • Step 2: Review introduction and complete contact information. Contact information and basic practice information is collected to prevent fraud and ensure that actual health professionals are participating in the survey. Your information is never forwarded to the AMA or used for tracking purposes. Make sure all of your information is correct.
  • Step 3: Identify a reference service. The survey includes a list of existing procedures and their designated codes to use as comparisons to the new CPT code being assessed. Select a procedure (code) from the list, for comparison to the surveyed procedure. In essence, you are asked to compare time, complexity and overall work of performing the surveyed procedure to an existing procedure from the list. Procedures on the list are referred to as “reference procedures.”

    The reference procedure and the surveyed procedure do not have to be equal in work — in your judgment. The reference procedure merely needs to provide you with a basis for comparison to the surveyed procedure.

    The reference list might include some CPT codes for services performed by other specialties. Do your best to select a reference procedure you are familiar with, so that you can compare it to the procedure being surveyed.
  • Step 4: Estimate your time. Using the patient vignette, this section of the survey asks you to estimate how much time it takes you (as a qualified healthcare professional) to perform the surveyed procedure, as it is described. This needs to be an honest and thoughtful consideration of the time it would take to perform the procedure as it is described in this particular survey.

    Note: Qualified healthcare professional time does not include services provided by technicians. It also does not include other services provided on the same day that can be coded separately.
  • Step 5: Compare new CPT code to reference code. Compare the mental effort and judgment, technical skill or physical effort, and psychological stress of the new code’s procedure with your chosen reference code’s procedure.
  • Step 6: Estimate work RVU — very important. In this final step, estimate the relative value unit (RVU). Consider the work RVU assigned to the reference procedure in developing your estimate. Set the work RVU of the new procedure “relative” to the work RVU of the reference procedure.