With an increased focus on payment and productivity measurement in health care, it is essential to understand the genesis and principles behind the Medicare Resource-Based Relative Value Scale (RBRVS) physician fee schedule. The majority of third-party payers, including a growing number of Medicaid programs and commercial payers, use variations of the Medicare RBRVS as their basis for physician payment. Many group practices have also adopted this system to benchmark physician productivity and determine variable compensation and bonus payments. Because pediatric care is underrepresented in any Medicare-based payment system analysis, unique aspects of physician work and practice expense may not be accurately reflected in the total relative value units (RVUs) for certain pediatric services. Despite this potential limitation, the American Academy of Pediatrics supports the use of Current Procedural Terminology (CPT) codes to report unique physician work and the RBRVS physician fee schedule as a uniform payment system. The American Academy of Pediatrics will continue to work to rectify perceived inequities of the RBRVS system as they pertain to pediatrics.