PatientRightsAdvocate.org Sues American Medical Association to Make Medical Billing Codes Freely Available to the Public

Lawsuit argues patients, health plans, and medical providers should not have to pay a private trade association to access codes required for use by federal and state law

WASHINGTON, Aug. 13, 2026 /PRNewswire/ -- Today, PatientRightsAdvocate.org (PRA) filed a lawsuit against the American Medical Association (AMA) seeking the right to make Current Procedural Terminology (CPT) freely and openly available to the American public.

CPT is the coding system used to classify medical procedures and services for billing and reimbursement. Federal law requires health care providers, insurers, and physicians to use CPT codes in electronic billing, and federal law and at least 45 states require their use in connection with Medicare, Medicaid, and other government programs.

Despite CPT's integral role in federal and state healthcare law, the AMA claims the coding system as its private copyrighted property and requires individuals and organizations to pay for access and licenses to use, reference, or display its contents. Members of the public must pay $137.89 to the AMA for a physical copy. The AMA charges health care providers an up-front annual fee of $82.50, as well as an additional annual fee of $18.50 per user, to use CPT codes in their practices. In 2025, the AMA reported $296.4 million in revenue from "Books and Digital Content," widely believed to be primarily attributable to this revenue stream.

"Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced," said Cynthia Fisher, founder and chair of PatientRightsAdvocate.org. "The 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."

The lawsuit argues that the AMA cannot lawfully prevent PRA from scanning and publishing the 2026 CPT codebook and future editions online in a searchable, user-friendly format available to the public at no charge. PRA in its complaint argues that the CPT is not copyrightable because it has been incorporated into federal and state law.

In addition, PRA argues that making CPT freely available to the public constitutes fair use. CPT derives its value from the government requiring its use, the lawsuit argues. Free publication would allow patients, employers, physicians, researchers, and policymakers to better understand the rules governing health care billing and reimbursement.

The lawsuit also argues that the AMA has misused its asserted copyright. A federal appeals court previously held that the AMA misused its CPT copyright through an agreement under which the federal government adopted CPT while agreeing not to use a competing coding system. PRA argues that the consequences of that arrangement remain embedded in the healthcare system today.

The Centers for Medicare & Medicaid Services (CMS) has also recently questioned the federal government's reliance on CPT. In its proposed 2027 physician payment rule, CMS sought public comment on the harms and challenges associated with the AMA's control of CPT licenses, possible alternatives to CPT as the national coding standard for physician services, and concerns about relying on a private organization whose decisions can influence physician payments.

About PatientRightsAdvocate.org

PatientRightsAdvocate.org is a 501(c)(3) nonprofit, nonpartisan organization focused on ushering in systemwide healthcare price transparency. Through advocacy, testimony, media, legal research and grassroots campaigns, the organization seeks actual, upfront healthcare prices that will greatly lower costs through a functional, competitive healthcare marketplace.

SOURCE Patient Rights Advocate