This article was updated February 2021.
From time to time, APA Services, Inc. may seek your valuable input in determining the appropriate value for the services you provide. You can provide this input by responding to the American Medical Association (AMA) Relative Value Scale Update Committee (RUC) survey about the time and complexity required in performing services.
These surveys are important to psychologists and other health care professionals because they help Medicare and other health insurers set reimbursement rates.
Here’s how RUC surveys are used to determine the payment rates for your services and instructions on how to respond.
How payment rates for psychological services are set
Once psychologists have completed the RUC surveys, APA Services reviews the data and develops service value recommendations related to the work and practice (business) expenses (i.e. supplies and equipment) involved with performing a procedure. APA Services then sends these recommendations to AMA.
AMA considers value recommendations from APA Services and other health care societies, and uses the data from RUC surveys to establish a specific relative value unit (RVU) for each CPT® code assigned to health care services and procedures.
The Centers for Medicare and Medicaid Services (CMS) sets Medicare reimbursement rates by multiplying the RVU for each CPT code by a set dollar figure (called the conversion factor).
CMS publishes their final decisions and approved values for the codes and services in the Medicare Physician Fee Schedule. Final CMS-approved values take effect yearly and commercial and private insurers refer to the fee schedule when establishing their own reimbursement rates.
How survey respondents are selected
APA Services identifies psychologists either through a random sampling of APA’s entire membership and/or from a random sample of psychologist members identified through APA divisions or state psychological associations. APA Services 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 APA Services 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.
It is critical to read the description of the new or revised 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.
The RUC survey refers to psychologists and other non-physician providers as “qualified healthcare professionals.”
The RUC defines “qualified healthcare professional” work to include:
- the time it takes to perform the service
- the mental effort and judgment
- the technical skill and physical effort
- the psychological stress that occurs when an adverse outcome has serious consequences
Here are the six (6) 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 five years, go ahead and complete the survey. If you have not performed this procedure within the last five years, 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 that is most similar in time and work to the new/revised CPT code descriptor and typical patient/service described, for comparison to the surveyed procedure. It is very important to consider the global period when you are comparing the new/revised code to the reference code. 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 and description of service periods, 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, and based on personal experience.
Note: Qualified health care 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 the survey procedure to a 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. Be sure to review the definitions for each element prior to completing this portion of the survey.
Step 6: Estimate work RVU—very important
In this final step, estimate the 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.
For questions about RUC surveys please contact APA Coding and Payment policy officer, Meghann Dugan-Haas.