Understanding the Current Procedural Terminology Process

This article describes the method by which U.S. health care services are valued and reimbursed, and the essential role practicing physicians, including breast imaging radiologists, and medical specialty societies play in this process. The American Medical Association has described the method for developing new and revised Current Procedural Terminology (CPT) codes as a 3-legged stool, with patient care as the seat supported by its legs: the CPT process (where the work is described), the Relative Value Scale Update Committee (RUC) process (where the work is valued), and coverage by Medicare (where the work is paid). Although the future direction of health care payment policy in the USA is uncertain and difficult to predict, CPT codes remain the foundation for the reimbursement of physician services. A working knowledge of the CPT process can be valuable to breast imaging radiologists, both for managing their practices at the current time and preparing them for future changes in payment policy.