AMA sued over CPT billing code copyright: 8 things to know

Billing is survival in most healthcare today, and the AMA has been taking its pound of flesh since 1966.

Every.

Single.

Bill.

Billers from solo doctors to mega-hospital systems must use current billing codes, or be denied payment. And the AMA meets quarterly to approve new codes. 

This Patients Rights Advocate v. AMA lawsuit has been a long time coming.

https://www.beckershospitalreview.com/legal-regulatory-issues/ama-sued-over-cpt-billing-code-copyright-8-things-to-know/

AMA sued over CPT billing code copyright: 8 things to know

Paige Twenter    |    August 13, 2026

PatientRightsAdvocate.org sued the American Medical Association on Aug. 13, seeking to void the AMA’s copyright over the CPT code set so the patient advocacy group can republish the codes online for free, according to court documents reviewed by Becker’s.

The Current Procedural Terminology codes dictate how much Medicare, Medicaid and private insurers pay physicians for their services. The lawsuit adds to mounting scrutiny of the AMA’s control over them.

Eight things to know:

1. PatientRightsAdvocate.org filed a declaratory judgment action, asking the court to confirm it can scan and post a purchased 2026 print edition of CPT on its website without infringing the AMA’s copyright. The nonprofit patient advocacy group said it has bought the codebook but has not copied or published it while it awaits a ruling.

The lawsuit was filed in the U.S. District Court for the Northern District of Illinois Eastern Division.

2. CPT is a set of five-digit codes that classify medical procedures and services. Federal law requires their use in nearly every EHR transaction, and the codes underpin how Medicare, Medicaid and at least 45 states set physician reimbursement. Medicare and Medicaid alone cover more than 144 million people and spend over $2 trillion a year.

3. The AMA, the nation’s largest physician association and lobbying group, charges for CPT access — $137.89 for a print edition, plus annual licensing fees for electronic use. It reported $296.4 million in revenue from “Books and Digital Content” in 2025, netting $267.5 million, according to the lawsuit.

The AMA’s annual CPT code royalties generate more than $300 million a year, according to recent data cited by The Washington Post.

4. PatientRightsAdvocate.org argues the AMA has no enforceable copyright on three grounds: that CPT cannot be copyrighted because it has been incorporated into federal and state law, that republishing it is fair use, and that the AMA has engaged in copyright misuse.

The complaint leans on the Supreme Court’s 2020 finding that “no one can own the law.”

“What we are seeking to do is allow them to be freely available, publishable and usable across the healthcare system,” PatientRightsAdvocate.org founder Cynthia Fisher told the Post. She said the AMA’s licensing fees “are adding to the costs of care and coverage.”

5. The lawsuit lands amid growing pressure on the AMA.

In a July 16 proposed rule for 2027 physician payments, CMS sought public comment on the “harms or challenges associated with AMA’s monopoly over CPT-4 licenses for healthcare entities.” The proposal is part of a broader Trump administration effort, outlined in July, to overhaul how Medicare pays physicians.

Sen. Bill Cassidy, MD, R.-La., has accused the AMA of abusing a “government-backed monopoly,” charging “exorbitant fees to anyone using the CPT code set.”

7. The patient advocacy group is not the first challenge to the AMA’s copyright. In 1997, the 9th U.S. Circuit Court of Appeals found the AMA had misused its CPT copyright by licensing the codes to the government only if it agreed not to use a competing coding system.

PatientRightsAdvocate.org is also fighting a related copyright case brought against it by the American Hospital Association over a separate billing manual, the UB-04, which is pending in the same court.

8. In response to questions about the lawsuit and its claims, an AMA spokesperson told Becker’s: “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.”

A spokesperson for PatientRightsAdvocate.org said its lawsuit supports efforts made by lawmakers and public officials who have questioned AMA’s control over billing standards.

“Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced,” Ms. Fisher said. “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.”

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.