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History of the RBRVS

December 1985
The Harvard National RBRVS Study is initiated.

September 1988
Harvard submits Phase I of the RBRVS Final Report to the Health Care Financing Administration (HCFA).

December 1989
President George Bush signs the Omnibus Budget Reconciliation Act of 1989, enacting a physician payment schedule based on an RBRVS.

November 1991
Initial Meeting of the AMA/Specialty Society RVS Update Committee (RUC) takes place: RUC Charter documents are created; RUC is approved for the formation of the Research Subcommittee, RUC Advisory Committee, and Health Care Professionals Advisory Committee.

January 1992
The Medicare RBRVS is implemented.

May 1992
The RUC considers the first relative value recommendation from a specialty society. The American College of Obstetricians and Gynecologists presents a work RVU recommendation for CPT code 58345 Transcervical introduction of fallopian tube catheter. HCFA accepts this first RUC recommendation.

July 1992
The RUC submits its first set of recommendations to HCFA for 253 new and revised CPT 1993 codes.

May 1994
The RUC submits its 1,000th work relative value recommendation for a new or revised CPT code. The RUC also submitted more than 300 recommendations to HCFA for carrier-priced or non-covered services, including preventive medicine visits.

January 1997
Implementation of the first Five-Year Review of the RBRVS. The RUC had submitted recommendations for more than 1,000 CPT codes, including increases to the E/M services. HCFA accepts 95% of the RUC’s recommendations, which include RVU changes to 400 codes.

November 1998
The RUC begins review of direct practice expense inputs. The Practice Expense Advisory Committee (PEAC) is created.

January 2000
Resource-Based Professional Liability Insurance (PLI) relative values are implemented.

January 2002
The second Five-Year Review of the RBRVS is implemented. The RUC submits recommendations for 870 CPT codes, including changes to nearly 500 work RVUs in October 2000. Implementation of Resource-Based Practice Expense Relative Values is finalized.

May 2003
The RUC submits recommendations from the PEAC on direct practice expense inputs. The PEAC has reviewed more than 3,500 codes, including all of the E/M codes.

March 2004
The PEAC has its final meeting. The PEAC has reviewed more than 6,500 codes.

January 2007
The third Five-Year Review of the RBRVS is implemented. The RUC submits recommendations for 751 CPT codes, including significant improvements to Evaluation and Management (E&M) services. CMS accepts 100 percent of the RUC's recommendations regarding E&M and 97 percent of the RUC's recommendations overall.

January 2009
CMS implements the first RUC recommendations resulting from efforts by the RUC's Five-Year Review Identification Workgroup to identify misvalued physician services. The CMS decision to implement all of the RUC recommendations results in a small increase to the 2009 Medicare Conversion Factor.