The American Medical Association has held a copyright over the Current Procedural Terminology (CPT) system since 1983 — the roughly 10,000 five-digit codes that every U.S. doctor, insurer, and hospital uses to bill Medicare, Medicaid, and private insurance. Federal law requires CPT's use in all electronic health billing; at least 45 states have embedded the codes in their Medicaid programs. But the codebook isn't free: a physical copy costs $137.89, electronic access starts at $82.50 a year plus $18.50 per user, and the AMA earns more than $300 million a year in licensing revenue from a system the government made mandatory. On August 13, 2026, PatientRightsAdvocate.org sued the AMA in federal court in Chicago, asking the court to let it publish the codes online for free. CMS had already opened a formal inquiry in July, calling AMA's position "an obvious conflict of interest."

The codes are mandatory federal and state law. Making people pay to read the law is indefensible.

CPT became public law the moment Congress mandated it. Cynthia Fisher, the founder of PatientRightsAdvocate.org, put it plainly: "No one can charge the public to access standards that are incorporated into state and federal law." PRA's lawsuit leans on three legal theories: the government-edict doctrine (courts have held that no one can own the law), fair use (nonprofit publication of a legally mandated standard), and copyright misuse (the 1983 exclusive agreement with the federal government that the Ninth Circuit already condemned in 1997).

Two recent rulings favor PRA. The Supreme Court ruled in 2020 in Georgia v. Public.Resource.Org that the government can't copyright its own legal texts. This past April, the Third Circuit found that nonprofit publication of legally-incorporated safety standards likely clears the fair use bar. PRA's attorneys are stacking both precedents.

The Senate HELP Committee chair is already on record agreeing. Sen. Bill Cassidy, M.D. (R-La.), accused the AMA of "abusing its government-endorsed CPT monopoly to charge every stakeholder" and called the arrangement "anti-patient and anti-doctor." He opened a formal Senate inquiry in October 2025.

2. The Codes Cost Money to Build (American Medical Association)

AMA maintains it invested decades of expert labor in CPT and copyright protects that investment.

Maintaining CPT takes real expert labor, and copyright funds that work. The AMA describes CPT as "the uniform language of medicine, updated continuously through an open, transparent process" involving collaboration across specialty medical societies, government, and industry. AMA argues that stripping the copyright strips the revenue that makes that possible.

The 1997 ruling banned the exclusivity deal, not the copyright. The Ninth Circuit found misuse in the 1983 exclusive agreement with HCFA, not in the underlying intellectual property. AMA has successfully defended that copyright in court for more than 40 years. It says it will "vigorously defend the AMA's intellectual property rights to ensure the continued access physicians and patients rely on."

AMA's revenue numbers are real, but so is its spending. The organization reported $513 million in total annual revenue, with $281 million from books and digital content. AMA argues those funds support a maintenance process no government agency currently has the capacity to replicate.

3. The Lawsuit Won't Fix This — CMS Should Build a Replacement (CMS, Health Affairs)

Even a court win for PRA leaves AMA controlling what codes exist and how they change.

CMS is already asking a harder question. In its July 2026 proposed 2027 Physician Fee Schedule, CMS didn't just question AMA's pricing — it questioned why the government relies on AMA at all. The agency cited "longstanding concern expressed over the Federal reliance on a private organization with such an obvious conflict of interest" and asked for public comment on alternatives to the CPT system entirely.

Free access to the codes doesn't end the monopoly over the codes. Even if PRA wins — even if anyone can publish CPT for free tomorrow — AMA still controls which codes exist, which get updated, and which get retired. Health Affairs analysts have argued the U.S. needs a single government-owned code set, built and maintained by a public body rather than a trade association that also lobbies Congress on physician payment rates.

There's a middle path. AMA could make basic CPT searchable for free while continuing to charge commercial software developers for API access and bulk data — preserving revenue while defusing the public-access complaint. AMA hasn't said it would accept that. CMS hasn't said it would require it.

Where This Lands

PRA's lawsuit is now before a federal judge in Chicago, with no trial date set. The AMA has signaled it will fight. CMS's July RFI is still accepting public comment, and that process could produce a regulatory fix — or a government-funded alternative — that bypasses the court entirely. Fisher and Cassidy want the current system declared unlawful. The AMA says removing the copyright kills the funding that keeps the codes accurate. CMS is asking whether it should be in this relationship at all.

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