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News
A nonprofit is suing the AMA to make CPT billing codes freely available online, arguing the codes are too embedded in federal law to be locked behind a paywall. The case could shake up how more than 11,000 medical billing codes are accessed and licensed. CMS is also weighing alternatives to CPT for its 2027 fee schedule.
A patient advocacy group, PatientRightsAdvocate.org (PRA), filed a federal lawsuit in August to invalidate the American Medical Association's (AMA) copyrights on Current Procedural Terminology (CPT) codes — the 11,000+ codes that underpin virtually all medical billing in the U.S. PRA wants to publish the codes online for free, arguing that a system mandated by federal rules and at least 45 states shouldn't require a paid license to use. The AMA is pushing back, calling CPT an essential, continuously updated standard.
The legal battle is heating up on multiple fronts. CMS opened a comment period on potential CPT alternatives for its 2027 fee schedule, and a 2023 DC Circuit ruling — finding that free publication of privately developed standards incorporated into law can qualify as fair use — may bolster PRA's case. Meanwhile, PRA is also facing a separate suit from the American Hospital Association over a hospital billing manual it similarly wants to publish freely.
By the Numbers
Why it matters: If the court sides with PRA, it could fundamentally change how billing codes are accessed — and raise big questions about who funds the ongoing work of updating them. For clinicians, nothing changes yet, but the outcome could affect how new procedure codes are created and reimbursed.
