AMA creates CPT codes, an obligatory code set for communications between providers and payers in the US, under HIPAA law. It also values the codes, through an elaborate, data and committee driven process (the relative value unit or RVU system). These codes and values are generally adopted by CMS for Medicare.
For years, AMA has had a product called RBRVS Data Manager - originally on CDs! - for years now, on the internet with a subscription (mine as an AMA member is $240/yr).
They did a big update & modernization to RBRVS Data Manager a couple years ago. I *think* they've done some extra updating this year, too.
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For example, here's I've searched on 95165 - preparation and provision of allergens - and you can see that there are no less than 9 different tabs, each pretty rich in information.
The tabs are
- General information
- Work RVU history
- Vignette/Service
- RUC rationale
- Geographic adjustment
- Physician time
- Claims data
- Billed together
- PE Inputs
You get to see the Patient Vignette and Service (work) description, which might help you if you are writing a CPT application yourself. Some Cat I lab codes have no vignette or service, some do.
- 81455 Vignette A 65-year-old male presents with lung and liver lesions. Pathologic evaluation of biopsies of these lesions reveals a poorly differentiated neoplasm of uncertain primary origin. Tumor tissue is submitted for a targeted genomic sequence analysis of a panel of 250 genes known to be informative in a broad array of cancers.
- 81455 Service Isolate high-quality DNA from the patient's tumor tissue and perform massively parallel sequencing on the tumor DNA, looking for mutations in 250 genes, which may be genomic targets for therapeutic management. Send the analytical results to a pathologist or other QHP for identification of mutations, interpretation, and preparation of a written report that specifies the patient's mutation status, which may contain information about diagnosis, prognosis, and patient management, to include information about targeted drug therapy.
- 81528 Vignette: A 55-year-old asymptomatic male presents for a routine annual examination. A colonoscopy for screening was recommended however the patient declined. The patient is offered a non-invasive screening with a multi-target DNA colorectal cancer screening test.
- 81528 Service: The test is comprised of a stool collection kit, fecal occult hemoglobin determination, and quantitative real-time target and signal amplification of 10 DNA markers. The quantitative biomarker results are analyzed through a logistic regression algorithm to produce a qualitative, single dichotomous patient result of negative or positive.
- 81500 Vignette: Patient is a 64-year-old white female who presents with complaints of pelvic pressure and pain. The pelvic exam find an 8 cm firm fixed right adnexal mass. The patient is sent for a pelvic ultrasound which shows a complex cystic and solid adnexal mass The physician and patient agree to surgery. Prior to scheduling the surgery, the physician requests a ROMA test so as to determine whether the case should be triaged to a physician with special expertise in gynecologic malignancy management.
- 81500 Service: The patient's serum is analyzed for CA125 using chemiluminescent microparticle immunoassay (CMIA) methodology and for HE4 using an enzyme immunometric assay (EIA) methodology. The results of the CA125 and HE4 assays along with the patient's menopausal status are entered into computer software which uses an algorithm to combine the results of the assays and menopausal status into a numeric score.
- 81493 Vignette: A 65-year-old female presents for neurologic evaluation of gradual cognitive decline. Measurement of phosphorylated Tau is requested.
- 81493 Service: Test the patient's sample for phosphorylated Tau by quantitative immunoassay and report the results.
SEE ALSO - RUC Records Too
Separately from the subscription RUC database above, if you sign up for a AMA logon, you can get voluminous RUC records for code valuations.
https://www.ama-assn.org/about/rvs-update-committee-ruc
https://www.ama-assn.org/about/rvs-update-committee-ruc/ruc-recommendations-minutes-voting
Here’s the short version:
What it is. The AMA’s RBRVS DataManager Online is a web-based reference for CPT® and HCPCS Level II codes with the RVUs, payment logic, and valuation background those codes carry in the RBRVS/Medicare Physician Fee Schedule. It’s aimed at coding, auditing, reimbursement policy, and internal education. (American Medical Association)
What you get.
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Code content & search: >19,000 CPT/HCPCS code descriptors plus ~5,500 AMA-exclusive CPT clinical scenarios that spell out pre/intra/post service work. (American Medical Association)
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Payment details: tools to calculate geographically adjusted Medicare payments (GPCIs/CF), plus direct practice-expense inputs (clinical staff, supplies, equipment) for each code. (American Medical Association)
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Rationale & RUC material: proprietary valuation insights and RUC rationales for work and PE recommendations—useful when you need to see why a code is valued the way it is. (American Medical Association)
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Utilization & crosswalks: >10 years of Medicare utilization per code and an ICD-10-CM ↔ CPT crosswalk (top five related codes). (American Medical Association)
Typical use cases. Revenue-cycle/audit, payer policy analysis, utilization review, and training physicians/analysts on how codes are valued and paid. (American Medical Association)
Pricing & access (historical reference). AMA lists it as an online subscription (the public store has shown list ~$320/yr; AMA member ~$240/yr in past listings). Exact current pricing may vary by year and member status. (American Medical Association)
Context & adoption. The product is cited by regulators and in workers’ comp rules as the source for RVU data/methodology, underscoring its use beyond provider offices. (Michigan.gov)
Recent note. In early 2024 the AMA expanded/modernized the online RVU database experience (widely noted by industry watchers), but the subscription concept and purpose remained the same. (Discoveries in Health Policy)
If you want, I can compare it feature-by-feature to alternatives (e.g., Optum’s Essential RBRVS data files or EZ-Fees fee-schedule tools) to clarify when AMA’s product is the better fit for a given task. (OptumCoding)
