<Dd> Although the RBRVS system is mandated by the Centers for Medicare and Medicaid Services (CMS) and the data for it appears in the Federal Register, the American Medical Association (AMA) maintains that their copyright of the CPT allows them to charge a license fee to anyone who wishes to associate RVU values with CPT codes . The AMA receives approximately $70 million annually from these fees, making them reluctant to allow the free distribution of tools and data that might help physicians calculate their fees accurately and fairly . </Dd> <P> RBRVS was created at Harvard University in their national RBRVS study from December 1985 and published in JAMA on September 29, 1988 . William Hsiao was the principal investigator who organized a multi-disciplinary team of researchers, which included statisticians, physicians, economists and measurement specialists, to develop the RBRVS . </P> <P> In 1988 the results were submitted to the Health Care Financing Administration (today CMS) to be used in the American Medicare system . In December of the following year, President George H.W. Bush signed into law the Omnibus Budget Reconciliation Act of 1989, switching Medicare to an RBRVS payment schedule . This took effect on January 1, 1992 . Starting in 1991, the AMA has updated RBRVS continually . As of May 2003, over 3500 corrections have been submitted to CMS . </P> <P> Physicians bill their services using procedure codes developed by a seventeen - member committee known as the CPT Editorial Panel . The AMA nominates eleven of the members while the remaining seats are nominated by the Blue Cross and Blue Shield Association, the Health Insurance Association of America, CMS, and the American Hospital Association . The CPT Committee issues new codes twice each year . </P>

Resource based relative value scale includes the following three parts