Relative Value Scale Update Committee (RUC)

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What is the RUC?

The Relative Value Scale Update Committee (RUC) is a committee involving the American Medical Association (AMA) and national medical specialty societies. It acts as an expert panel in developing recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding the relative value of physician services under the Medicare physician fee schedule. The AMA is responsible for staffing the RUC and providing logistical support for the RUC meetings.

  • The RUC is composed of 31 members, 21 of whom are appointed by major national medical speciality societies.
  • Four RUC seats rotate every two years; two reserved for an internal medicine subspecialty, one for a primary care representative, and one for any other specialty.
  • The remaining six seats are held by the RUC Chair, the Co-Chair of the RUC Health Care Professionals Advisory Committee Review Board, and representatives of the AMA, American Osteopathic Association, the Chair of the Practice Expense Review Committee and CPT Editorial Panel.
  • The AMA Board of Trustees selects the RUC chair and also the AMA representative to the RUC.
  • Individual RUC members are nominated by the specialty societies and are approved by the AMA.

The AAFP's Position on the RUC

The AAFP has long advocated for improvements in the RUC. The AAFP, along with many other stakeholders, believes the RUC currently undervalues primary care services. This may stem from the data inputs and methodology used by the RUC and from the under-representation of primary care on the RUC.

As a participant society in the RUC, the AAFP acknowledges that the committee has extensive expertise and a unique infrastructure and perspective that facilitate the valuation of codes under the Medicare physician fee schedule. However, CMS may rely too heavily on the RUC’s recommendations, which are based on self-reported survey data. Further, the long-term and ongoing actions of the RUC have, historically, been biased toward procedures and new technology and not preventive care and chronic disease management. Although the RUC provides valuable expertise, the review process would benefit if CMS had an additional means of identifying mis-valued services and validating relative values. This should include collecting and analyzing supporting evidence by medical specialty societies and experts who are less invested financially in the outcome.

The AAFP will continue to advocate strongly, both inside and outside the RUC, for what we believe are the necessary changes to its structure. The RUC needs to realize the importance of a greater level of transparency to those who vote and the value of additional external representatives as it relates to their expertise and their positive impact on the culture of a group such as the RUC.