{"id":160919,"date":"2026-08-19T06:34:19","date_gmt":"2026-08-19T14:34:19","guid":{"rendered":"https:\/\/xira.com\/p\/2026\/08\/19\/patient-group-sues-ama-says-the-org-shouldnt-be-charging-for-cpt-codes\/"},"modified":"2026-08-19T06:34:19","modified_gmt":"2026-08-19T14:34:19","slug":"patient-group-sues-ama-says-the-org-shouldnt-be-charging-for-cpt-codes","status":"publish","type":"post","link":"https:\/\/xira.com\/p\/2026\/08\/19\/patient-group-sues-ama-says-the-org-shouldnt-be-charging-for-cpt-codes\/","title":{"rendered":"Patient Group Sues AMA, Says The Org Shouldn\u2019t Be Charging For CPT Codes"},"content":{"rendered":"

The post Patient Group Sues AMA, Says The Org Shouldn\u2019t Be Charging For CPT Codes<\/a> appeared first on Above the Law<\/a>.<\/p>\n

PatientRightsAdvocate.org<\/a> filed a lawsuit<\/a> against the American Medical Association<\/a> this week, arguing the group has no right to copyright the current procedural terminology (CPT) system<\/a> that all providers use to code and get paid.<\/p>\n

The nonprofit wants to scan and publish the CPT codebook online for free instead of forcing patients and providers to pay the AMA for access.<\/p>\n

The lawsuit, filed in the U.S. District Court for the Northern District of Illinois, rests on the argument that CPT codes have become so deeply woven into federal and state law that they no longer qualify for copyright protection at all.<\/p>\n

PRA pointed to a legal doctrine holding that \u201cno one can own the law\u201d \u2014 and noted that federal regulations and at least 15 state laws incorporate CPT by reference, effectively making the code set part of the text of binding regulations.\u00a0<\/p>\n

The complaint revives a legal theory that has already succeeded before. In 1997, the Ninth Circuit found<\/a> the AMA had misused its CPT copyright by striking a deal with federal regulators that required the agency now known as CMS to use CPT to the exclusion of any competing coding system.<\/p>\n

\u201cThe government made CPT codes part of the operating law of our health care 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,\u201d Cynthia Fisher, founder and chair of PRA, said in a statement<\/a>.<\/p>\n

The AMA pushed back on the lawsuit\u2019s premise.<\/p>\n

\u201cCPT 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\u2019s intellectual property rights to ensure the continued access physicians and patients rely on,\u201d a spokesperson for the trade group said in a statement emailed to MedCity News<\/em>.<\/p>\n

The AMA charges members of the public $137.89 for a physical copy of the CPT codebook. Practices that want to use the codes electronically, such as in billing software, must pay an additional annual licensing fee of $82.50, plus additional user-based fees.\u00a0<\/p>\n

The complaint noted that the AMA reported $296.4 million in revenue from \u201cbooks and digital content\u201d in 2025, netting $267.5 million in profit. PRA argued that sales in this category are overwhelmingly driven by CPT sales and licensing, though there is no way to separate out revenue from CPT products alone.<\/p>\n

PRA isn\u2019t the only one sounding the alarm. In October, Senator Bill Cassidy (Republication-Louisiana) sent a public letter<\/a> to the AMA accusing it of \u201cabus[ing] [its] government-backed monopoly by charging exorbitant fees to anyone using the CPT code set.\u201d\u00a0<\/p>\n

Cassidy\u2019s letter also pressed the AMA for details on how much revenue it derives from CPT sales and licensing, its administrative costs to produce the codes and how it sets pricing.<\/p>\n

The lawsuit also lands as CMS itself has begun questioning the arrangement, asking for public comment last month in its proposed 2027 physician payment rule<\/a> on potential alternatives to CPT and the \u201charms or challenges\u201d tied to the AMA\u2019s licensing monopoly.\u00a0<\/p>\n

Whether PRA succeeds hinges on whether the court agrees that a code set the government requires by law can still be privately owned.<\/p>\n

Photo: Svenja-Foto, Getty Images<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The post Patient Group Sues AMA, Says The Org Shouldn\u2019t Be Charging For CPT Codes appeared first on Above the Law. PatientRightsAdvocate.org filed a lawsuit against the American Medical Association this week, arguing the group has no right to copyright the current procedural terminology (CPT) system that all providers use to code and get paid. […]<\/p>\n","protected":false},"author":3,"featured_media":160920,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[16],"tags":[],"class_list":["post-160919","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-above_the_law"],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/xira.com\/p\/wp-content\/uploads\/2026\/08\/legal-a6p48R.jpg?fit=728%2C480&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/posts\/160919","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/comments?post=160919"}],"version-history":[{"count":0,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/posts\/160919\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/media\/160920"}],"wp:attachment":[{"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/media?parent=160919"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/categories?post=160919"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/xira.com\/p\/wp-json\/wp\/v2\/tags?post=160919"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}