PatientRightsAdvocate.org filed a federal lawsuit against the American Medical Association on August 13, 2026, challenging the private trade association’s control over the Current Procedural Terminology coding system. The legal complaint argues that patients, health plans, and medical providers should not have to pay fees to access billing and reimbursement codes that federal and state laws mandate them to use.
The Cost and Legal Mandate of CPT Codes
Federal law requires healthcare providers, insurers, and physicians to use CPT codes in electronic billing. In addition, federal law and at least 45 states require these codes for government programs like Medicare and Medicaid, according to prnewswire.com. Despite this mandatory government integration, the American Medical Association claims the coding system as its private copyrighted property.
The association charges individuals $137.89 for a physical copy of the codebook. For medical practices, the organization requires an up-front annual fee of $82.50 alongside an additional annual fee of $18.50 per user to utilize the codes in their practices. Financial reports from 2025 show the American Medical Association generated $296.4 million in revenue from books and digital content, a revenue stream prnewswire.com reports is widely believed to be primarily attributable to this revenue stream.
“Americans should not have to pay a private trade association for permission to see how their medical care is billed and priced,” said Cynthia Fisher, founder and chair of PatientRightsAdvocate.org, according to prnewswire.com.
Legal Arguments Behind the Lawsuit
The lawsuit contends that the coding system is not copyrightable because state and federal governments have incorporated the standards into law. PatientRightsAdvocate.org asserts that publishing the 2026 codebook and future editions online in a searchable, free format for the public constitutes fair use under copyright principles.
Furthermore, the complaint alleges that the American Medical Association has misused its asserted copyright. The filing points to a previous federal appeals court ruling holding that the association misused its CPT copyright through an agreement where the federal government adopted the codes while agreeing not to use a competing system. The lawsuit argues those historical arrangements remain embedded in the healthcare system today.
Federal Scrutiny of Private Coding Monopolies
The Centers for Medicare & Medicaid Services has also questioned the federal government’s reliance on the proprietary coding system. In its proposed 2027 physician payment rule, the agency requested public comment on the harms and challenges linked to the American Medical Association’s control of CPT licenses.
Federal regulators specifically sought input on potential alternatives to CPT as the national coding standard for physician services and voiced concerns regarding reliance on a private organization whose decisions can influence physician payments.