Despite efforts to correct the system, cognitive services remain undervalued. For example, compare the valuation of screening colonoscopy (Current Procedural Terminology code [CPT] 45378) to the first hour of critical care (CPT 99291), recognizing that taking responsibility for a physiologically unstable patient requires not only a significant fund of knowledge and the ability to apply best practice recommendations that are constantly evolving, often on a month-to-month basis, but also the ability to deal with family dynamics in an emotionally charged situation. For the 2014 Medicare Physicians Fee Schedule, CPT 45378 is valued at 6.19 relative value units while 99291 is valued at 6.26 relative value units. Our societies have had representation at the RUC since its inception with no notable change in the value of codes specific to our services. We can hope that with more articles such as those by Laugesen1 and Kumetz and Goodson,2 societies representing our practice domain will actively engage in efforts to improve this flawed system.