PatientRightsAdvocate.org Files Lawsuit Against AMA for Public Access to Medical Billing Codes

PatientRightsAdvocate.org Takes Action Against AMA

In a bold move toward enhancing healthcare transparency, PatientRightsAdvocate.org (PRA) has filed a lawsuit against the American Medical Association (AMA). This lawsuit asserts the need for Current Procedural Terminology (CPT) to be publicly accessible without charge.

What is CPT?

CPT codes are crucial in the healthcare framework, utilized to classify medical procedures and services for billing and reimbursement purposes. As mandated by federal regulations, healthcare providers, insurers, and physicians are required to use these codes in electronic billing. Furthermore, various state laws necessitate their usage in relation to Medicare, Medicaid, and other government programs.

Despite the CPT codes being integral to the U.S. healthcare system, the AMA claims copyright ownership over these codes, maintaining that individuals and organizations must pay for access and licenses to use, reference, or display them. The costs can be burdensome: a physical copy of the CPT codebook costs the public $137.89, while healthcare providers face an up-front fee of $82.50, plus additional annual charges per user.

In 2025, the AMA disclosed that it generated $296.4 million from "Books and Digital Content," a significant portion of which stemmed from licensing fees related to CPT.

The PLA's Argument for Fair Access

Cynthia Fisher, founder of PRA, emphasized, "Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced." Her organization argues that since CPT codes are incorporated into federal and state laws, they should not be subject to copyright and hidden behind a paywall. There is a growing recognition that these charges contribute unnecessarily to the rising costs of healthcare.

PRA's lawsuit argues that the AMA cannot legally inhibit the dissemination of the 2026 CPT codebook and its future versions in an online format. They insist the CPT codes are essential for public awareness regarding the rules governing healthcare billing and reimbursement, which should be accessible to all at no cost.

Moreover, PRA asserts that making these codes freely available represents fair use, as their value arises from the fact that the government mandates their application in healthcare practices. This increased accessibility would empower patients, employers, researchers, and policymakers by providing them the knowledge necessary to navigate the complex healthcare billing landscape.

AMA's Control Under Scrutiny

The lawsuit further implies that the AMA has misused its copyright. A prior federal appeals court ruling indicated that the AMA had engaged in copyright misuse through an agreement that allowed the federal government to adopt CPT in exchange for not using an alternative coding system. PRA contends that the implications of this agreement continue to affect the healthcare system.

Concerns regarding the AMA's control over CPT have gained traction recently. The Centers for Medicare & Medicaid Services (CMS) has proposed a review of the government's reliance on CPT, even seeking public input on the challenges presented by the AMA's license management and potential alternatives to the CPT standard.

A Movement Toward Healthcare Price Transparency

PatientRightsAdvocate.org is a non-profit entity committed to encouraging price transparency within the healthcare sector. The organization engages in legal research, advocacy efforts, and grassroots campaigns to facilitate upfront healthcare pricing, thereby fostering a competitive healthcare marketplace aimed at reducing costs.

The outcome of this lawsuit could have sweeping implications, potentially altering the accessibility of medical billing information vital for patients and healthcare practitioners alike. As this case advances, the conversation surrounding healthcare transparency, accessibility, and the commercialization of essential medical information continues to unfold. By pushing for this lawsuit, PRA is highlighting a fundamental right to information that underpins the very fabric of healthcare in America.