Who Owns the Codes Doctors Use to Get Paid?

For most medical practices, CPT codes aren’t controversial. They’re part of the daily routine. A physician performs a service, a coder assigns the appropriate CPT code, the claim goes to the payer, and the code identifies what service was performed and helps determine how that service is reported and, in many cases, reimbursed.

Most practices don’t stop to ask a more fundamental question: who controls the code set used across the U.S. healthcare system? That question is now at the center of a federal lawsuit that could have implications far beyond the American Medical Association and the organization challenging it.

On August 13, PatientRightsAdvocate.org sued the AMA in federal court, seeking a ruling that would allow the organization to publish the CPT code set publicly and free of charge. The complaint challenges the AMA’s asserted copyright in CPT and argues, among other things, that the codes cannot remain privately controlled after being incorporated into federal and state law. Those are the plaintiff’s legal arguments; the court has not ruled on them.

For physicians, this isn’t simply a dispute over a coding manual. It raises a larger question about the infrastructure behind medical billing.

Why CPT Is Different From an Ordinary Coding Manual

The AMA develops and maintains the CPT code set, which has become deeply embedded in the U.S. healthcare payment system. CMS uses CPT codes in Medicare, and CPT is incorporated into numerous federal and state healthcare payment and reporting requirements. That combination is what makes the lawsuit unusual.

PatientRightsAdvocate.org isn’t simply arguing that CPT should cost less. Its complaint takes a more fundamental position: once CPT has been incorporated into law and regulation, the AMA shouldn’t be able to use copyright law to restrict public access to the codes.

The organization also argues that republishing CPT would be permissible under copyright law, including under its fair-use theory, and alleges copyright misuse. Those claims remain allegations in an active lawsuit.

For a medical practice, the more practical question is what could change if the plaintiff succeeds.

Your Practice Would Not Suddenly Stop Using CPT

This is the first distinction worth making. The lawsuit doesn’t mean practices can stop using licensed CPT resources today. It doesn’t mean CPT has already entered the public domain. And the filing doesn’t change current coding requirements or automatically eliminate the AMA’s existing licensing arrangements.

For now, practices continue to operate under the current system. The significance of the lawsuit lies in what could happen if the court ultimately accepts some or all of the plaintiff’s arguments, which is where the issue becomes relevant to billing departments.

The Cost Is Bigger Than the Codebook

The AMA charges for CPT access, including a listed price of $137.89 for a print edition and licensing fees for electronic use, according to Becker’s reporting on the lawsuit. The lawsuit also cites AMA financial figures, and recent reporting has put annual CPT-related royalty revenue at more than $300 million. Those figures shouldn’t be read as meaning every dollar represents direct profit from CPT licensing.

For an individual physician, the direct cost may not look enormous. But CPT is used throughout a much larger ecosystem — billing companies rely on it, EHR and practice-management systems incorporate it, coding and clinical software vendors license it, payers use it, hospitals and physician groups use it, and government programs rely on it.

The licensing question therefore extends well beyond whether one physician purchases a CPT publication. It concerns access to a coding system that sits underneath a substantial portion of U.S. healthcare reimbursement.

What Would Free Access Actually Change?

The immediate answer is narrower than some headlines might suggest. If CPT became freely accessible, physicians wouldn’t suddenly receive higher reimbursement. Payers wouldn’t automatically change their fee schedules. Medicare wouldn’t start paying more for existing services. A CPT code would still describe the same service.

The immediate change would be access and licensing. Organizations that currently pay for CPT access could potentially use the code set without the same licensing restrictions, which could matter for software companies, billing organizations, researchers, healthcare analysts, and smaller practices building their own tools. It could also make the coding system easier for patients and other members of the public to review.

But the financial impact on a practice would depend heavily on how vendors and other parts of the healthcare ecosystem respond.

CPT Codes Are Not the Same Thing as Medicare Fees

This distinction is critical. A CPT code identifies a service. It doesn’t, by itself, determine what Medicare or a commercial payer will pay for that service. Payment depends on a much larger set of variables: payer policy, fee schedules, geographic adjustments, modifiers, coverage rules, contracts, and, for Medicare, the payment methodology established by CMS.

So if the lawsuit eventually changes the copyright or licensing environment around CPT, practices shouldn’t expect their reimbursement to change automatically. The code could become easier to access. The payment attached to the code is a separate question.

Why CMS Is Part of the Bigger Story

The lawsuit arrives at an interesting moment. CMS is currently taking public comments on its CY 2027 Medicare Physician Fee Schedule proposed rule, issued July 14, 2026. The proposed rule addresses Medicare physician payment and other Part B policies, with comments due September 14.

Separately, Becker’s reports that the 2027 proposed rule includes a request for information on the potential harms or challenges associated with the AMA’s CPT-4 licensing arrangement.

That doesn’t mean CMS has taken a position in the lawsuit between PatientRightsAdvocate.org and the AMA, and it doesn’t mean CMS is proposing to replace CPT or eliminate the AMA’s role in maintaining the code set. The connection is more specific: CMS is examining the CPT licensing issue as part of its broader review of physician payment policy, which makes the timing significant. If a court ultimately changes the legal status of CPT, the consequences would extend into an ecosystem that includes Medicare payment systems, commercial payers, billing companies, and healthcare software vendors, and that’s the part worth watching.

There Is Legal History Behind This

The current lawsuit isn’t the first legal challenge involving the AMA’s control of CPT. In 1997, the Ninth Circuit considered an earlier dispute involving the AMA’s copyright and its licensing arrangement with the federal government, and the court found that the AMA had misused its CPT copyright in that particular arrangement. Becker’s reports that the current complaint cites that history as part of its broader legal argument.

The current case is different. PatientRightsAdvocate.org is advancing several arguments, including that CPT cannot remain protected by copyright after being incorporated into law, that republishing it could qualify as fair use, and that the AMA has engaged in copyright misuse. Those claims remain allegations in an active lawsuit — a complaint describes what the plaintiff is asking a court to accept, not that those legal theories are correct.

What Should Practices Do Right Now?

Probably nothing dramatic. This isn’t a reason to change your coding workflow tomorrow. It is, however, a good reason to understand how CPT enters your practice’s systems and what licensing arrangements sit behind that access.

Billing and practice-management teams should know where their CPT data comes from — it may be built directly into an EHR, practice-management system, encoder, or other coding product. They should also know which vendor maintains that information and whether the practice has any direct licensing obligations.

For practices that rely heavily on third-party coding tools, it’s worth understanding whether a change in CPT licensing could affect pricing, access, or functionality. Those questions are useful regardless of how the lawsuit ends.

The Bigger Issue Is Control of the Billing Infrastructure

Healthcare billing depends on infrastructure that most practices rarely think about until something changes. A practice may employ its physicians, maintain its patient records, and control its internal billing workflow, but the systems used to describe services, transmit claims, process payments, and determine reimbursement rely on standards and commercial relationships that extend far beyond the practice itself.

CPT is one of the most important examples. The lawsuit puts a fundamental issue before the court: how should copyright apply when a privately maintained coding standard becomes embedded in government regulation and is used throughout a public payment system? The answer could have consequences beyond the parties to this particular case.

What Happens If PatientRightsAdvocate.org Wins?

Even a ruling in the plaintiff’s favor wouldn’t immediately create a completely different healthcare billing system. Software vendors would need to adapt. Existing licensing agreements could require review. The AMA’s role in maintaining and updating the code set would still have to be addressed. And healthcare organizations would still need a reliable, standardized CPT system.

Making access free wouldn’t eliminate the cost of maintaining the codes. New procedures still need to be evaluated. Existing codes need to be revised. Obsolete codes need to be retired. The code set needs to be updated as medicine changes.

That leaves an important practical question for the industry: if access to CPT becomes free, how would the work of maintaining the national coding standard be funded and organized? The lawsuit doesn’t answer that question.

Why Practices Should Watch This Case

Most coding changes reach a practice in a familiar form — a new code, a deleted code, a revised descriptor, or a new payer policy. This case is different because it challenges part of the infrastructure underneath the coding system itself.

If the lawsuit succeeds, the immediate consequences could center on copyright and licensing. Over time, the effects could reach software vendors, billing companies, payers, healthcare transparency efforts, and the way practices obtain coding information. If the AMA prevails, the existing licensing model would remain in place, though the broader debate over CPT access would likely continue.

For practices, there’s no reason to change coding procedures today, but there is a reason to watch the case, because the question eventually being decided is bigger than the price of a codebook: when a coding standard becomes part of the machinery used to administer healthcare payments, how much control over that standard can remain in private hands? That answer could affect virtually everyone involved in submitting a medical claim.

Sources

• Becker’s Hospital Review, “AMA sued over CPT billing code copyright: 8 things to know,” August 13, 2026.
• PatientRightsAdvocate.org, “PatientRightsAdvocate.org Sues American Medical Association to Make Medical Billing Codes Freely Available to the Public,” August 13, 2026.
• Georgetown University Law Center, Litigation Tracker — PatientRightsAdvocate.org, Inc. v. American Medical Association.
• Centers for Medicare & Medicaid Services, CY 2027 Medicare Physician Fee Schedule Proposed Rule. Washington Post, “Group sues AMA seeking transparency over Medicare billing codes,” August 13, 2026.
• American Medical Association, CPT resources and information.