PatientRightsAdvocate.org Sues AMA Over CPT Coding Paywalls

Current Procedural Terminology (CPT) codes serve as the mandatory backbone of medical billing for Medicare, Medicaid, and private insurance across at least 45 states. While federal regulations compel providers and insurers to utilize this system, the AMA maintains strict copyright control over the data. The organization currently charges $137.89 for a physical copy of the codebook and levies annual licensing fees on healthcare providers, including an $82.50 base fee plus $18.50 per individual user.

In 2025, the AMA reported $296.4 million in revenue from books and digital content, a sum largely attributed to these mandatory fees. Cynthia Fisher, founder of PatientRightsAdvocate.org, contends that the association is effectively taxing the public for the privilege of understanding how their own medical care is priced. The lawsuit asserts that because the government has incorporated these codes into the operating law of the healthcare system, they cannot be held as private property.

Beyond the copyright claim, the litigation highlights the broader systemic impact of this dependency. The Centers for Medicare & Medicaid Services has recently signaled its own concerns, formally requesting public comment on the potential risks of relying on a private entity to set national coding standards. The plaintiff aims to publish the 2026 CPT codebook online in a searchable, free format, arguing that transparency is essential to fostering a competitive and functional healthcare marketplace.