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.
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