The American Medical Association is facing heightened scrutiny from Republican lawmakers about its role in shaping physician payment, The Washington Post reported Dec. 2.
Five things to know:
1. Sen. Bill Cassidy, R-La., sent a letter to the AMA Dec. 1, requesting details on how it develops and licenses CPT billing codes used for Medicare and commercial reimbursement. The action follows a formal letter Mr. Cassidy, chairman of the Senate Committee on Health, Education, Labor and Pensions, sent to the AMA in early October, requesting detailed information about its control of the CPT coding system.
2. Mr. Cassidy and other Republican lawmakers have criticized the scale of the AMA’s coding enterprise, alleging it generates substantial revenue and gives the association disproportionate influence over payment policy. They argue that the AMA’s longstanding process lacks transparency and has contributed to payment structures that favor procedures over primary and preventive care.
3. The inquiry comes after the Trump administration released its 2026 Medicare Physician Fee Schedule final rule Oct. 31, which reduces reimbursement for surgeries and other procedures by 2.5% and shifts funds toward chronic disease management and prevention.
4. HHS Secretary Robert F. Kennedy Jr., has also reportedly considered an overhaul of Medicare’s physician payment model to incentivize primary care and preventive services.
5. The AMA did not immediately provide a comment to Becker’s but said it intends to respond to Mr. Cassidy’s inquiry.
