For decades, the American Medical Association’s Relative Value Scale Update Committee has played a key role in shaping Medicare physician payment rates, according to a July 21 article by The New York Times. The committee recommends how much time and effort various medical services require, forming the basis for some of Medicare’s compensation decisions.
Here are 10 things to know:
1. The Times reports that the RUC has faced criticism for favoring procedural and specialist medicine over primary care. Much of its data comes from small, voluntary physician surveys, which some argue are outdated. The AMA noted in a statement with Becker’s that the survey protocols were developed by academic researchers and federal officials “because they knew Medicare depended on expert physician insight to create Medicare payment policy that mirrors the evolution of science, technology and innovations in patient care.”
2. The AMA also highlighted several recent RUC-led reforms:
“The most recent improvements in 2021-2023 were implemented and led to more than $6 billion in redistribution from other services to evaluation and management,” the AMA said in an explainer on the RUC’s efforts to support primary care.
3. A new regulation proposed under the Trump administration would reduce reliance on the AMA-led RUC. It suggests replacing physician surveys with broader data sources, such as hospital and billing data.
4. AMA President Bobby Mukkamala, MD, strongly criticized the proposal:
“The American Medical Association believes that proposals to exclude or limit the input of expert practicing physicians and healthcare professionals in the development of Medicare payment policy would ultimately harm patients and represents a radical departure from the time-tested CMS decision-making process,” he said in a statement shared with Becker’s. ““There is no substitute for relying on experienced practicing physicians when creating Medicare payment policy. No one knows more about what is involved in providing services to Medicare patients than the physicians who care for them…By substituting arbitrary and flawed proposals in place of front-line, real-world knowledge from expert physicians, Medicare is proposing to cut itself off from the most credible insights into the complexities of patient care, which will ultimately lead to lower quality care, inferior health outcomes and a less sustainable Medicare system.”
5. Starting in 2026, the proposed rule would impose a 2.5% across-the-board cut to procedural and test-based services to account for presumed “efficiency” gains over time. Office visits and other time-based services would be exempt from these reductions.
6. The rule also proposes changes to how practice costs are calculated based on care setting. This could reduce payments to hospital-based practices while increasing reimbursement for office-based services.
7. The estimated changes in physician pay vary by specialty. Primary care physicians and some specialists, such as allergists and vascular surgeons, would see increases. Conversely, neurosurgeons and infectious disease specialists would likely see cuts. The proposal purports it is a part of a broader attempt to rebalance financial incentives away from high-volume procedural work.
8. While the rule aims to diminish RUC’s influence, CMS has not presented a fully developed alternative methodology. The agency is soliciting public feedback on what data or models should replace the current process.
9. The proposal is still under review. Stakeholders have 60 days to submit public comment, and CMS is expected to issue a final decision in October. If adopted, the changes would take effect in January 2026.
10. In response to criticism, the AMA pointed to long-term shifts in payment rates as evidence that RUC efforts have increasingly supported primary care.
“Since the inception of the RBRVS, Medicare payment for a mid-level office visit has increased from $31 in 1992 to $89 in 2025,” the AMA statement continued. “In comparison, payments for cataract surgery have decreased from $941 to $522 and payments for MRI of the lumbar spine have decreased from $485 to $188.”
This, the organization argues, demonstrates a redistribution away from high-paying procedures toward essential time-based care.
