The American Medical Association (AMA) faces a new legal challenge over the Current Procedural Terminology (CPT) coding system after a patient advocacy group asked a federal court to invalidate the organization’s longstanding copyrights and permit the codes to be published online at no cost.

PatientRightsAdvocate.org (PRA), a Massachusetts-based nonprofit focused on healthcare price transparency, filed the lawsuit on August 12 in US District Court. The group says it has purchased a copy of the 2026 CPT codebook and intends to scan and publish it on its website in a searchable, user-friendly format if the court confirms it can legally do so, the complaint said.

AMA Faces Growing Scrutiny Over CPT Codes

The lawsuit is the latest development in a growing debate over the AMA’s ownership and licensing of CPT, a set of more than 11,000 codes that form the basis for medical billing and reimbursement.

While CPT codes are already publicly available through the Centers for Medicare and Medicaid Services (CMS), that access does not make the database free for unrestricted use. The AMA requires individuals and organizations using CPT content to have permission or an appropriate license.

PRA argues that those restrictions should not apply to a coding system incorporated into federal billing requirements and required by at least 45 states when submitting claims for reimbursement, court documents said.

“We believe the most important change is that physicians and providers, as well as patients, employers, and other payors, would no longer need to pay a tax to the AMA simply to access and make use of the legal standards that govern billing,” Rich Danker, PRA spokesperson and former assistant secretary for public affairs under US Department of Health and Human Services Secretary Robert F. Kennedy Jr, told Medscape Medical News. “This will remove a source of waste and inefficiency from the system.”

The lawsuit asks the court to declare that the AMA’s CPT copyrights are invalid and unenforceable and that PRA’s proposed publication of the complete code database constitutes fair use and not copyright infringement.

The AMA said it plans to fight the lawsuit.

“CPT serves as the uniform language of medicine, updated continuously through an open, transparent process that reflects evolving clinical care,” an AMA spokesperson told Medscape Medical News in a statement on the organization’s behalf. “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.”

Calls for Greater Transparency

PRA argues that greater public access to CPT could improve healthcare price transparency and deepen understanding of billing and reimbursement procedures.

Republican Senator Bill Cassidy, MD, chair of the Senate Health, Education, Labor, and Pensions Committee, launched an inquiry last year into what he called the AMA’s “monopoly” over CPT and pressed the organization to disclose how much it earns from licensing the codes. It remains unclear whether the AMA provided that information.

In July, CMS began seeking public comment on potential alternatives to CPT in its proposed 2027 Physician Fee Schedule, including the “harms or challenges associated with AMA’s monopoly over CPT-4 licenses” and whether licensing costs inhibit innovation. The agency said the request is part of the Trump administration’s Make America Healthy Again initiative. Comments are due on September 14.

The lawsuit is not PRA’s first copyright dispute. The American Hospital Association sued PRA in December after it alleged the advocacy group sought to make the UB-04 hospital billing manual freely available. PRA, in its complaint against AMA, said the two cases raise “many of the same legal issues.”

Pamela Samuelson, JD, co-director of the Berkeley Center for Law and Technology, UC Berkeley, raised questions in a 2007 article cited in PRA’s complaint about whether standards such as CPT should receive copyright protection when their use is mandated by government. She told Medscape Medical News that her views have not changed and pointed to a more recent case.

The DC Circuit’s opinion in American Society for Testing and Materials (ASTM) v Public Resource suggests that fair use is more plausible now than in the past, Samuelson said. In that 2023 case, the court held that a nonprofit’s free online publication of privately developed standards incorporated into law was fair use and that there was “no quantifiable evidence of past or future market harm” to the plaintiffs.

Who Pays to Maintain a ‘Free’ CPT?

In the complaint, PRA states that the AMA reported $296.4 million in “books and digital content” revenue in 2025. PRA alleges, “upon information and belief,” that CPT licenses and sales represent the “overwhelming share” of that revenue. The AMA has not publicly disclosed how much revenue it earns specifically from CPT.

The lawsuit says a physical copy of CPT costs $137.89. However, purchasing the codebook does not authorize copying, transmitting, or using its contents in an electronic product, according to the AMA’s website; those uses require separate permission or licensing. 

AMA’s published licensing rates vary by use. For internal use, its current rate schedule includes an $82.50 fee plus an $18.50 per-user royalty under one licensing model, while organizations distributing products containing CPT may be subject to other fees and royalties.

Removing the licensing structure and making CPT freely available raises another question: Who would fund its maintenance and updates?

“My understanding is that the AMA receives a substantial amount of revenue from CPT licensing,” Joseph Marine, MD, electrophysiologist and professor at the Johns Hopkins University School of Medicine, Baltimore, who has written about and testified before legislators on healthcare policy issues, told Medscape Medical News. “It should also be noted that there is substantial cost for the AMA associated with generating and maintaining the current CPT coding system.”

The AMA has not publicly detailed how much it spends to maintain and update CPT. However, its 21-member CPT Editorial Panel meets three times annually to consider applications for new, revised, and deleted codes, with additional reviews of some codes occurring between meetings.

If the AMA lacked the resources to update CPT, PRA’s complaint alleges that federal and state governments would have “a strong incentive to step in and financially support its continued production.”

Marine said CMS could potentially fund the AMA to continue the work or take over responsibility itself. But changing the current model could disrupt the creation of codes for new procedures, he said, potentially delaying reimbursement and adoption into practice.

“Even with all of its many flaws, the US healthcare system has grown reliant on the current CPT model, and it is what everyone knows,” Marine said.

For now, PRA says it will not reproduce CPT on its site. If the lawsuit is successful, the group plans to purchase each new annual edition and make it available for free online.

Samuelson and Marine reported having no relevant financial disclosures. Since 2023, Samuelson has served on the board of trustees of Public.Resource.Org, the defendant in the ASTM case discussed in this article.

Steph Weber is an award-winning freelance journalist specializing in healthcare and law.