Tyler Scheid

Much of the current outrage treats CPT as if the AMA invented it to game Medicare, but the facts does not support that assertion. The AMA published the first edition of CPT in 1966, the same year Medicare and Medicaid launched, and that first edition was almost entirely surgical procedures aimed at standardizing operative documentation. There was no RUC, no RBRVS, and no federal payment system built around it yet. It was the federal government that came to CPT, not the other way around. HCFA adopted CPT for Medicare Part B billing in 1983 and extended it to Medicaid outpatient surgical billing in 1986, choosing to build on an existing, functioning private standard rather than create a new one from scratch. The Health Insurance Portability and Accountability Act of 1996 went further, directing HHS to name national standards for electronic health transactions, and HHS designated CPT as that standard in 2000. Three separate federal decisions, spanning administrations of both parties, chose to keep using CPT. The governance and makeup of the committees are also designed to ensure a fair process. The CPT Editorial Panel, which writes and revises the codes themselves, and the RUC, which values the physician work behind those codes, are two different committees with two different memberships. The Editorial Panel's physician seats are nominated by national medical specialty societies, and its other seats go to the Blue Cross Blue Shield Association, America's Health Insurance Plans, the American Hospital Association, and CMS itself, none of whom are part of the AMA. RUC members, separately, operate under AMA structure and function rules that require them to exercise independent judgment rather than advocate for their own specialty's financial interest when a code comes up for review. No matter your opinions on the ultimate output of the committees, the claim that one trade association secretly runs both the code book and the price tag with no outside check does not match how these two committees are actually built.