Patient advocacy nonprofit PatientRightsAdvocate.org has sued the American Medical Association, arguing the trade group has no legal right to charge the public for access to CPT codes, the system used nationwide to bill and reimburse medical care.
Federal law requires providers, insurers and physicians to use CPT codes in electronic billing, and federal law and at least 45 states require their use for Medicare, Medicaid and other government programs. Despite that mandate, the AMA claims CPT as its private copyrighted property and charges individuals and organizations to access, reference or display it. Providers pay an upfront annual fee of $82.50 plus $18.50 per user to use the codes in their practices, according to the lawsuit.
Cynthia Fisher, founder and chairman of PatientRightsAdvocate.org, said the arrangement forces patients and providers to pay for the ability to understand their own medical bills.
“Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced. 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,” Ms. Fisher said. “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.”
The dispute centers partly on the AMA’s licensing revenue. In 2025, the association reported $296.4 million in revenue from “Books and Digital Content,” a category PatientRightsAdvocate.org says is largely attributable to CPT licensing fees.
The lawsuit argues the AMA has misused its copyright claim over CPT. PatientRightsAdvocate.org points to Practice Management Information Corp. v. American Medical Association, in which a federal appeals court ruled in 1997 that the AMA misused its CPT copyright through an exclusivity agreement under which the federal government adopted CPT in exchange for the AMA’s promise not to use a competing coding system. The group argues making CPT freely available to the public would qualify as fair use, in part because the code set derives its value from the government mandate requiring its use.
The lawsuit lands amid existing congressional scrutiny of the AMA’s control over CPT. Sen. Bill Cassidy, MD, R-La., has pressed the AMA over the transparency of its CPT licensing revenue and the influence the code set gives the association over physician payment policy.
In a statement shared with Becker’s, an AMA spokesperson stated 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,” the statement continued. “We will vigorously defend the AMA’s intellectual property rights to ensure the continued access physicians and patients rely on.”
While payers have brought similar lawsuits against the organization over specific CPT codes, a broader lawsuit against the organization’s copyright use of the codes has not been filed since the late 1990s.
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