The authors' objective in this study was to establish panel procedures for revising the Medicare Resource-Based Relative Value Scale (RBRVS). They conducted four pilot panels, composed of 46 physicians from different specialties (including primary care), to rate total physician work. One panel examined 80 urological services, another examined 80 ophthalmological services, and the last two considered the merit of appeals from five specialty and subspecialty societies to 68 and 48 services, respectively. All ratings were relative to a multispecialty reference set of established values. Measures included physicians' preliminary and final ratings and detailed notes of the group discussions conducted between the ratings. Results indicate that a panel process for refining RVWs is practical and reasonable, provided that panelists are provided with a valid reference set for comparison purposes and provided that care is taken that all members feel comfortable engaging in the discussion.