Patient Advocacy Group Files Lawsuit Challenging AMA’s CPT Code Copyright

A patient advocacy organization has filed a lawsuit against the American Medical Association, arguing the group lacks the right to copyright the Current Procedural Terminology (CPT) system that healthcare providers rely on for billing and reimbursement.

The nonprofit aims to digitize and publish the CPT codebook freely, eliminating the need for patients and providers to pay fees for access.

The legal action, submitted in the U.S. District Court for the Northern District of Illinois, contends that CPT codes have become so deeply embedded in federal and state regulations that they no longer qualify for copyright protection.

Plaintiffs reference the legal principle that “no one can own the law,” noting that federal rules and at least 15 state statutes incorporate CPT by reference, effectively integrating the code set into binding regulatory text.

The complaint revives a legal theory with prior success: in 1997, the Ninth Circuit ruled that the AMA misused its CPT copyright by arranging a deal requiring the agency now known as CMS to adopt CPT exclusively, sidelining alternative coding systems.

“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,” said Cynthia Fisher, founder and chair of the advocacy group. “These egregious charges ultimately increase healthcare costs 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 incorporated into state and federal law.”

The AMA defends its position, stating that CPT serves as the uniform language of medicine, continuously updated through an open, transparent process reflecting evolving clinical care. The organization says it brings expertise and scale to the work, convening collaboration across medicine, government and industry, and that it will vigorously defend its intellectual property rights to ensure continued access for physicians and patients.

The AMA currently charges $137.89 for a physical copy of the CPT codebook, plus an annual electronic licensing fee of $82.50 for use in billing software, along with additional user-based fees.

According to the AMA’s 2025 financial reports, the organization generated $296.4 million in revenue from books and digital content, yielding $267.5 million in profit. The advocacy group argues this category is overwhelmingly driven by CPT sales and licensing, though exact figures for CPT-specific revenue cannot be isolated.

The controversy extends beyond the litigation. In October, Senator Bill Cassidy (R-Louisiana) sent a public letter to the AMA accusing it of “abusing its government-backed monopoly by charging exorbitant fees to anyone using the CPT code set.” The letter pressed the AMA for details on CPT-related revenue, administrative costs and pricing methodology.

Timing adds further pressure, as the Centers for Medicare & Medicaid Services has recently sought public comment on potential alternatives to CPT and the “harms or challenges” associated with the AMA’s licensing monopoly in its proposed 2027 physician payment rule.

Whether the lawsuit succeeds will depend on whether the court agrees that a code set required by law can remain privately owned.

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