Which code set is utilized in the RBRVS prospective payment system?

The Resource-Based Relative Value Scale (RBRVS) is a payment system used by Medicare and other payers to determine reimbursement rates for physician services. The coding for services under this system primarily relies on the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes.

CPT codes are used to describe medical, surgical, and diagnostic procedures, while HCPCS includes codes for other services not covered by CPT, such as certain non-physician services and durable medical equipment. Together, these code sets facilitate the identification and reimbursement of services performed by healthcare providers, making them essential for the RBRVS structure.

Other code sets mentioned—like ICD-10-CM, which is used for diagnosis coding; LOINC, which is primarily for laboratory tests; and SNOMED CT, which is a comprehensive clinical terminology—serve different purposes in the healthcare system and are not utilized in the context of the RBRVS payment mechanism. Thus, the reliance on HCPCS and CPT in this context is key to understanding the operational framework of the RBRVS prospective payment system.