Radiology’s future depends on strong, informed and active representation in the AMA’s Specialty Society Relative Value Scale Update Committee process.
FROM THE CHAIR OF THE COMMISSION ON ECONOMICS
Gregory N. Nicola, MD, FACR
Aytekin Oto, MD, MBA, FACR
Professor of Radiology and Surgery and Chair of the Department of Radiology at the University of Chicago
Guest Columnist
The AMA’s Specialty Society Relative Value Scale Update Committee (RUC) plays a central role in defining the economic architecture of medical practice in the United States. Through a rigorous and highly structured process, the RUC evaluates the physician work, practice expense and professional liability components of CPT® codes. These recommendations directly inform the CMS as they update the Medicare Physician Fee Schedule, shaping reimbursement policies across all payers. Because almost every radiology service is defined, valued and reimbursed within this framework, the work conducted at the RUC has profound implications for every radiology practice, both academic and private.
Although I had long heard about the RUC process, I had never had the opportunity to observe it directly. When Gregory N. Nicola, MD, FACR, chair of the ACR Commission on Economics, generously invited me to attend a RUC meeting in Chicago in September 2025, I was truly excited. The meeting itself was an extraordinary experience: an intensive, data driven, four-day forum in which representatives from all specialties present survey results, defend physician work values, debate relative intensities, justify practice expense inputs and negotiate cross-specialty consensus. Each CPT code reviewed carries significant weight, not only for reimbursement but also for the perceived value of the service, the stability of practice models and the long-term viability of high-quality patient care. The entire process is meticulous, transparent and evidence based. Every specialty must develop robust data, engage with peers and articulate the rationale for its recommendations. These deliberations ultimately shape the valuation of services that millions of patients receive each year.
Each CPT code reviewed carries significant weight, not only for reimbursement but also for the perceived value of the service, the stability of practice models and the long-term viability of high-quality patient care.
Radiology’s voice in this environment is essential. Under the leadership of Dr. Nicola, the ACR Commission on Economics has earned a reputation for exceptional fairness, analytical rigor and collaborative engagement. The ACR team includes both academic and private practice radiologists as well as highly skilled ACR staff who consistently deliver outstanding survey design, high-quality data analysis and thoughtful valuation arguments. Their preparation is exhaustive and rooted in a deep understanding of clinical practice, workflow, technology and patient safety. They work closely with RUC advisers, ACR leadership and subspecialty experts to ensure that every valuation reflects the realities of contemporary imaging and interventional radiology.
The Commission’s work is extraordinarily demanding. These volunteer leaders devote countless hours to reviewing codes, analyzing survey results, conducting practice expense research, meeting with subspecialty experts, preparing presentations and coordinating negotiation strategies across specialties. They must navigate complex methodological questions, anticipate challenges and defend radiology’s perspective with clarity, professionalism and strong evidence. Their work directly affects radiologist reimbursement, but, more importantly, it safeguards patient access to high-quality imaging services nationwide.
Observing the RUC process firsthand left a deep impression on me. The dedication, discipline and expertise of the ACR team were evident in every session. Their ability to synthesize clinical realities, operational constraints, economic modeling and regulatory frameworks into well-supported recommendations is simply remarkable. They advocate for radiologists and for patients with integrity and authority. Their preparation is meticulous, their teamwork seamless and their professionalism unwavering. The esteem they command from other specialties is clear throughout the deliberations.
The influence of their work extends well beyond the confines of a single meeting. The valuations they defend impact the financial sustainability of radiology practices, the stability of academic departments, the viability of imaging services in community settings and the adoption of innovative technologies. When radiology codes are undervalued, access to care can be compromised, innovation discouraged and practices placed under substantial strain. When codes are valued appropriately, radiologists are able to deliver timely, safe and high-quality care. This is why the RUC process matters so deeply and why the contributions of the ACR Commission on Economics are indispensable.
I am profoundly grateful to Dr. Nicola, the ACR Commission on Economics and the RUC advisers for their tireless work and for welcoming me as an observer. Their efforts often take place behind the scenes, but they are foundational to the vitality and future of our specialty. Their expertise, preparation and leadership exemplify the very best of radiology.
As radiologists, we all benefit from this work, and we all share a responsibility to support it. I strongly encourage colleagues across diagnostic radiology, interventional radiology, radiation oncology and nuclear medicine to engage more actively with ACR’s economic and regulatory activities. Our specialty needs radiologists who understand valuation, survey design, coding, practice economics and the legislative environment. Whether by volunteering for committees, responding to surveys, contributing subspecialty expertise or advocating for fair valuation, every radiologist can make a meaningful impact.
Radiology’s future depends on strong, informed and active representation in the RUC process. The ACR Commission on Economics has shown extraordinary leadership, but they cannot carry this burden alone. Our collective involvement will ensure that imaging remains accessible, appropriately valued and positioned to advance patient care for decades to come.
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