The American healthcare system is a labyrinth of complex billing, shifting regulations, and opaque pricing structures. At the center of this web lies a system of alphanumeric shorthand known as Current Procedural Terminology (CPT) codes. These codes are the lingua franca of American medicine, used to bill insurers, define clinical procedures, and organize the vast data flows of the U.S. health economy. Yet, for years, a single private entity—the American Medical Association (AMA)—has held a firm grip on the copyright to these codes, charging significant fees for their use.
Now, that monopoly is facing its most significant legal challenge to date. PatientRightsAdvocate.org, a nonprofit dedicated to health system transparency, has filed a federal lawsuit challenging the AMA’s right to claim ownership over a system that has become, by virtue of government mandate, the law of the land.
The Core of the Conflict: Ownership vs. Public Access
The crux of the lawsuit filed by PatientRightsAdvocate.org is a fundamental legal principle: "No one can own the law."
The advocacy group argues that because federal and state governments have formally incorporated CPT codes into their regulatory frameworks—mandating their use for Medicare, Medicaid, and private insurance billing—these codes have effectively entered the public domain. By forcing clinicians, hospitals, and patients to pay for access to these codes, the AMA is, according to the suit, imposing a "paywall" on the very infrastructure of American medical commerce.
"Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced," says Cynthia Fisher, founder and chair of PatientRightsAdvocate.org. The lawsuit posits that even if the AMA’s copyright were once valid, the current arrangement constitutes a form of "copyright misuse," preventing the public from understanding the financial mechanics of their own healthcare.
A Chronology of Contention
The lawsuit is the latest escalation in a long-standing simmering tension regarding the AMA’s influence over federal payment policies.
- Decades of Dominance: Since the mid-1960s, the AMA has developed and maintained the CPT code set. Over time, the federal government—specifically the Centers for Medicare & Medicaid Services (CMS)—adopted these codes as the standard for reporting physician services.
- The October 2024 Scrutiny: The political pressure began to mount in October 2024 when Senator Bill Cassidy, MD (R-La.), the ranking member of the Senate Health, Education, Labor and Pensions (HELP) Committee, issued a pointed letter to then-AMA President Dr. Bobby Mukkamala. Cassidy demanded transparency regarding the AMA’s revenue models and the governance of the CPT Editorial Panel.
- The Dissatisfactory Response: The AMA’s subsequent response in late October was dismissed by Senator Cassidy as "anything but open and transparent," further fueling calls for a legislative or judicial intervention into the AMA’s data-gathering processes.
- The CMS Pivot: In early 2025, CMS issued a formal "request for information" (RFI), signaling that the federal government is exploring alternatives to the current fee-for-service payment structures. The RFI explicitly referenced concerns about the inherent conflict of interest in relying on a private organization to provide the data that determines the financial value of physician services.
- The February 2025 Lawsuit: Following the legislative and regulatory friction, PatientRightsAdvocate.org officially filed its lawsuit in federal court, seeking a declaratory judgment that the CPT codes are free for public use.
Economic Implications and Revenue Streams
The financial stakes of this battle are significant. The AMA is a powerful trade association, and its "books and digital content" category—which includes CPT licensing—reported a staggering $296.4 million in revenue for 2025.
While the AMA and external analysts argue that it is difficult to isolate exactly how much of that revenue is derived solely from CPT licensing versus other publications, the figure serves as a lightning rod for critics. For the average physician, the costs are tangible: an upfront annual fee of $82.50 to access the system, plus an additional $18.50 per user per year. For large hospital systems and health tech firms, these licensing fees scale into the millions.
Fisher argues that these costs are not merely line items for hospitals; they are inflationary pressures that ultimately trickle down to the patient. "These egregious charges are increasing the costs of healthcare for American patients and employers, unnecessarily," she contends. By creating a barrier to information, the AMA keeps the "black box" of medical billing closed, preventing patients from comparing prices or auditing their own medical bills for accuracy.
Official Responses and the Defense of Intellectual Property
The AMA has maintained a firm stance throughout the controversy, framing the issue not as one of greed, but of stewardship. In an official statement, an AMA spokesperson emphasized that the CPT code set is not a static list, but a "uniform language of medicine" that requires constant, expert-led evolution.
"The AMA brings expertise and scale to this work, convening collaboration across medicine, government, and industry," the spokesperson stated. The association argues that the revenue generated from licensing is essential to funding the massive administrative undertaking of updating the codes to reflect new medical technologies, pharmaceutical breakthroughs, and changes in clinical practice.
The AMA has vowed to "vigorously defend" its intellectual property rights, arguing that without a centralized, well-funded body to maintain the code, the system would devolve into chaos, harming the very physicians and patients that critics claim to protect.
The Conflict of Interest: A Regulatory Dilemma
Beyond the question of copyright law lies a deeper concern regarding the influence of private trade associations on public policy. CMS relies on the AMA to provide data on the time and resources required to perform various medical procedures. These recommendations form the basis of the Medicare Physician Fee Schedule.
The "conflict of interest" argument is multifaceted. Critics note that because the AMA represents the interests of physicians, it has an inherent incentive to advocate for higher valuations of medical services. When the entity providing the data for reimbursement is also the entity profiting from the licensing of the coding system, the perception of bias is difficult to overcome.
In its recent RFI, CMS acknowledged these concerns, noting that the "federal reliance on a private organization with such an obvious conflict of interest" is a subject of "longstanding concern." This suggests that even if the lawsuit against the AMA does not result in the total dissolution of the copyright, the federal government may move to decouple its payment methodologies from the AMA’s proprietary data streams.
Implications for the Future of Healthcare
The outcome of this lawsuit could send shockwaves through the American healthcare system. If the court rules in favor of PatientRightsAdvocate.org, the immediate effect would be the democratization of medical billing data. Hospitals, third-party software developers, and patients would have unfettered access to the codes, potentially leading to a new wave of transparency tools, price-comparison apps, and more efficient billing software.
Conversely, a victory for the AMA would solidify the status quo, effectively confirming that proprietary standards can indeed become embedded in public law without losing their intellectual property protections.
Ultimately, this case serves as a microcosm of the broader struggle for control over health data. As healthcare becomes increasingly digitized, the entities that control the "metadata" of the industry—the codes, the algorithms, and the classification systems—hold immense power.
As the litigation proceeds, the medical community and the public will be watching closely. Whether the CPT codes remain a proprietary asset or become a public utility, the fundamental question remains: Who should hold the keys to the language of medicine? For the advocates, the answer is clear: the public, whose health and finances are governed by these codes, should have the right to understand them without paying a fee. For the AMA, the answer remains rooted in the belief that the system’s integrity depends on its continued, centralized stewardship.
The courtroom will soon decide which of these visions will prevail in the future of American healthcare.
