AMA Sued Over Its ‘Paywalled’ Billing Codes

Should Current Procedural Terminology (CPT) codes be free for all patients and clinicians to use? That’s the question being asked in a recent lawsuit against the American Medical Association (AMA), which holds the copyright to the billing codes.

PatientRightsAdvocate.org sued the physicians group in federal court earlier this month, claiming that the AMA in fact “has no valid copyright in CPT” and “has no right to withhold CPT from the public and charge hefty fees for access.”

“Federal and state law expressly incorporate CPT by reference, and copyright precedent has long recognized that ‘no one can own the law,'” the lawsuit continues. “And even if the AMA’s copyright were valid, the public is still entitled to access to CPT under well-established principles of fair use and copyright misuse.”

To obtain a physical copy from the AMA, members of the public must pay $137.89, the lawsuit notes. To use the codes, healthcare providers pay an upfront annual fee of $82.50 as well as an additional annual fee of $18.50 per user, the advocacy group said in a press release.

“Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced,” Cynthia Fisher, the founder and chair of PatientRightsAdvocate.org, said in the release. “The government made CPT codes part of the operating law of our healthcare system, but the AMA keeps it behind a paywall and charges patients, doctors, hospitals, health plans, employers, and tech firms for the privilege of understanding it. These egregious charges ultimately are increasing the costs of healthcare for American patients and employers, unnecessarily. We are asking the court to affirm a basic principle: No one can charge the public to access standards that are incorporated into state and federal law.”

“This lawsuit is a core component of our mission to make healthcare more affordable, accountable, and transparent,” Fisher said in an email. “Once CPT codes are freely available, as they should be, the public will for the first time have clear visibility into how their medical bills are constructed.”

The statement from the advocacy group said that of the $296.4 million the AMA reported in 2025 revenue under the category “books and digital content,” CPT code revenue is “widely believed to be primarily attributable to this revenue stream.” However, other sources cautioned that it’s impossible to separate out individual items in that category, so attributing that high a number to CPT alone is unjustified.

Asked to comment on the lawsuit, an AMA spokesman said in an email that “CPT serves as the uniform language of medicine, updated continuously through an open, transparent process that reflects evolving clinical care. The AMA brings expertise and scale to this work, convening collaboration across medicine, government, and industry. We will vigorously defend the AMA’s intellectual property rights to ensure the continued access physicians and patients rely on.”

The AMA’s CPT code ownership has been a controversial topic of late.

Last October, Sen. Bill Cassidy, MD (R-La.), chair of the Senate’s health committee, sent a letter to AMA’s president at the time, Bobby Mukkamala, MD, seeking an explanation of how CPT codes are generated, whose input is incorporated in developing them, and how much revenue the publication and licensing of these codes provides.

“I am particularly offended by the AMA abusing its government-endorsed CPT monopoly to charge every stakeholder in the healthcare system significant amounts of money while advancing an anti-patient agenda,” Cassidy wrote.

In his letter, Cassidy also asked what steps AMA leadership has taken to “ensure that this mandatory process incorporates the feedback and concerns of all providers.” The AMA replied on Oct. 23, but Cassidy said he was dissatisfied with the response, calling it “anything but open and transparent.”

Last month, the Centers for Medicare & Medicaid Services (CMS) issued a request for information seeking ideas for alternatives to the current fee-for-service-based payment system for physicians who treat Medicare patients, which could include changes to the CPT coding system.

The authors of the request noted that the AMA collects its own data to develop recommendations for CMS on how much each CPT code should be worth. “There has … been longstanding concern expressed over the federal reliance on a private organization with such an obvious conflict of interest as providing information on the time and resource requirements to conduct physician services when this information may influence their own payment,” the authors of the request stated.