PatientRightsAdvocate Sues AMA Over $300 Million Medicare Billing Code Royalties
Updated
Updated · The Washington Post · Aug 13
PatientRightsAdvocate Sues AMA Over $300 Million Medicare Billing Code Royalties
1 articles · Updated · The Washington Post · Aug 13
Summary
PatientRightsAdvocate.org sued the American Medical Association on Thursday, seeking to break the AMA’s copyright control over CPT billing codes and make them freely searchable online.
CPT codes are used by Medicare and states to set reimbursement for physicians and other practitioners, giving the AMA influence over billions of dollars in healthcare payments.
More than $300 million a year in AMA royalties is at the center of the challenge, with the advocacy group arguing the licensing fees raise the cost of care and coverage.
The lawsuit lands as the Trump administration weighs whether to stop using AMA codes and Senate HELP Chairman Bill Cassidy investigates whether the group is improperly profiting from them.
Could a lawsuit over copyrighted medical codes finally expose the hidden fees driving up your healthcare bills?
What happens to medical innovation if the private system controlling healthcare billing is suddenly forced to become free?
The $300 Million AMA CPT Monopoly: Lawsuits, Political Backlash, and the Future of U.S. Healthcare Billing Reform
Overview
PatientRightsAdvocate.org has sued the AMA to challenge its copyright over CPT billing codes, which are required by the federal government but controlled and licensed for profit by the AMA. This system forces hospitals and insurers to pay substantial royalties, acting as a hidden tax that inflates healthcare costs for patients. The AMA’s financial dependence on these royalties creates conflicts of interest, as large corporate healthcare systems become its main patrons, while independent physicians lose autonomy and face declining pay. Meanwhile, the complexity and proprietary nature of CPT codes hinder price transparency, innovation, and contribute to billing errors and fraud, prompting federal agencies to seek major reforms.