RUC Process

The AMA/Specialty Society Relative Value Update Committee (RUC) is a unique multi-specialty committee tasked with making relative value recommendations to CMS for new and revised codes, as well as annually updating relative value units (RVUs) to reflect changes in medical practice.

The purpose of the RUC process is to provide recommendations to CMS for use in annual updates to the new Medicare relative value scale. These recommendations are based on data collected from surveys of practicing physicians regarding the time, intensity and complexity of new and revised CPT codes.

The Survey Process Requires Physician Input

For the RUC survey process to succeed, the cooperation and participation of practicing physicians is essential. It is only with your input that we can provide the RUC and CMS with accurate data so gastroenterology services can be fairly valued by Medicare. Many private insurers also base their rates on a percentage of Medicare, resulting in a wide and significant impact of this process.

We realize practicing physicians are faced with increasing demands on their time, but we believe this is an important, valuable and unique opportunity for any practicing gastroenterologist. By participating in a RUC survey, you will be able to have direct input on the valuation of the services you provide.

If you are contacted via email to participate in RUC surveys, we urge you to complete them.

The Endoscopy Survey Timeline

Procedure Family

Code Range

Survey Date

Esophagoscopy 43200–43234


EGD 43235–43259 Completed
Dilation 43450–43458 Completed
Upper GI EUS

Esophagoscopy: 43231, 43232

EGD: 43237, 43238, 43242, 43259

EGD/PEG 43246 Completed
ERCP 43260–43273 Completed
Pouchoscopy/Ileoscopy 44380–44386 Completed
Flexible Sigmoidoscopy 45330–45345 Completed
Colonoscopy 44378–45392 Completed
Colonoscopy through Stoma, Colotomy 44388–44397, 45355 Completed
Liver Elastography 91200 Completed
Trans-Oral Esophagogastric Fundoplasty 43210 Completed
Capsule Endoscopy 91110 and 91111 Completed
Moderate Sedation  99152 Completed
Change of Gastrostomy Tube 43760 March 2-16, 2017

Note: Procedures and dates are subject to change.

The Basics of the RUC Survey Process

When new codes are established or existing codes are revised, a survey of physicians providing that service is conducted by the relevant medical specialty society. The purpose of the survey is to measure physician work involved in performing the procedure to determine an accurate relative value recommendation for the service. AGA, ASGE and ACG conduct surveys for gastroenterology services, analyze the results and present recommendations to the RUC.

The AMA defines physician work as:

  • Physician time it takes to perform a service.
  • Physician mental effort and judgment.
  • Physician technical skill and physical effort.
  • Physician psychological stress that occurs when an adverse outcome has serious consequences.

In May of every year, the RUC submits its recommendations to CMS. In the summer, through the federal regulations process, CMS publishes proposed work values. After the public comment process, the new values are finalized and implemented on Jan. 1 of the following year.

Read more about the RUC.

Download a PDF presentation on understanding the survey instrument.

Read the RUC Survey Instrument FAQ.

How Medicare Sets Physician Payment Rates

In 1992, Medicare implemented a cost-based physician fee schedule. For each of the greater than 7,000 services on the fee schedule, an RVU is assigned based on the time and intensity of physician work, practice expense and cost of professional liability insurance necessary to provide the service. To determine the Medicare fee, a service's RVUs are multiplied by a dollar conversion factor that is updated annually. A geographic adjustment is also made.

When Medicare transitioned to a physician payment system based on the Resource-Based Relative Value Scale (RBRVS), AMA anticipated the effects of this change and formulated a multi-specialty committee. This committee, known as the AMA RVS Update Committee (RUC), has made numerous recommendations to CMS that have significantly affected the Medicare physician payment schedule by giving physicians a voice in shaping Medicare relative values. The RUC, in conjunction with the Current Procedural Terminology Editorial Panel, has created a process through which specialty societies can develop relative value recommendations for new and revised codes. The RUC carefully reviews survey data presented by specialty societies and develops recommendations for consideration by CMS. AGA, ASGE and ACG are active participants in the RUC.

Updated March 2015