---
title: A Lawsuit Challenges the Paywall Around the Codes on Your Medical Bill
description: A nonprofit is suing the American Medical Association to make CPT medical billing codes free. Here is what a win would, and would not, change for patients.
author: Darie Nani (Editor-in-Chief)
updated: 2026-08-27T23:16:46.127Z
canonical: https://richhealthmagazine.com/article/cpt-medical-billing-codes-ama-lawsuit
image: https://cdn.nanimediahouse.com/cpt-codes-paywall-lawsuit-150550.webp
categories: Health
content_type: News
region: United States
publication: Rich Health Magazine
schema_type: Article
---

Look at an itemized medical bill and you will find a column of five-digit numbers next to each charge. The number 99213 means a standard office visit. Those numbers are CPT codes, and they are the language that tells your insurer, your doctor, and you what service was actually performed. The code set that defines them is owned, copyrighted, and licensed for a fee by the American Medical Association. If you want the official book that explains what each code means, a member of the public pays $137.89 for a physical copy.

On August 13, 2026, a price-transparency nonprofit called PatientRightsAdvocate.org filed suit against the AMA in the U.S. District Court for the Northern District of Illinois, asking the court to let it publish the entire CPT code set for free. The case puts a long-standing arrangement in front of a judge: the government requires nearly everyone in American health care to use these codes, and a private membership organization controls who may reproduce them and at what price.

## PatientRightsAdvocate Wants to Publish the Codes for Free

The group is seeking a declaratory judgment that it may publish the CPT code set freely, plus an injunction to stop the AMA from collecting licensing fees. As reported by [Bloomberg Law](https://news.bloomberglaw.com/health-law-and-business/ama-sued-over-opacity-of-billing-codes-by-transparency-group) and Healthcare Dive, PatientRightsAdvocate rests its case on three legal theories: copyright misuse; the argument that once CPT was written into federal law it lost its copyright protection; and the argument that a nonprofit publishing the codes qualifies as fair use.

The nonprofit's core argument is that a code set the government forces people to use should not sit behind a private license. As of late August 2026 there had been no ruling or hearing, and the AMA had not yet filed a formal court response.

## The Government Requires These Codes Almost Everywhere

CPT, short for Current Procedural Terminology, is mandatory rather than optional. CMS required it for Medicare Part B in 1983 and for Medicaid in 1986. Under HIPAA, the Department of Health and Human Services adopted CPT as the [national standard for electronic health transactions](https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Code-Sets), and it is codified in federal regulation at 45 CFR 162.1002. At least 45 states require its use.

That mandate is why the license is unavoidable: providers cannot bill federal programs without CPT, so they cannot escape the AMA's fee if they want to get paid.

## The License Brings the AMA More Than $300 Million a Year

Licensing the CPT code set is a substantial source of revenue for the AMA. Its 2025 filing reported $296.4 million in “Books and Digital Content” revenue, widely attributed to CPT licensing, and the program brings in more than $300 million a year. Providers pay roughly $82.50 a year plus $18.50 per user, and the $137.89 charge for a printed copy falls on any member of the public who wants one.

## The AMA Says the Fees Pay for Keeping the Codes Current

The AMA has said it will “vigorously defend” its intellectual property, and it makes a substantive case for the arrangement. It calls CPT “the uniform language of medicine” and says the code set is developed through an “open, transparent process.” The codes change every year as new procedures, devices, and treatments are named and defined. The AMA's position, reported by Bloomberg Law and MedCity News, is that the licensing revenue funds that continuous maintenance, carried out through its CPT Editorial Panel, which updates the set annually. Removing the revenue, the AMA argues, would weaken the work that keeps the codes accurate and usable.

## The Law Here Is Genuinely Unsettled

Courts have circled this question before without settling it. In Practice Management v. AMA, decided by the Ninth Circuit in 1997, the court found the AMA had misused its copyright by conditioning a license on the government agreeing not to use rival code systems. In the same ruling, though, the court held that the federal mandate to use CPT did not strip the AMA of its copyright.

A different court went the other way five years later. In Veeck v. SBCCI, the Fifth Circuit held in 2002 that model codes adopted into law enter the public domain. Whether “incorporation by reference” into federal law strips a private code of copyright remains unresolved across the circuits, as a Congressional Research Service report has noted. PatientRightsAdvocate is asking the Illinois court to resolve the question in patients' favor, and the AMA can point to real precedent on its side.

## Federal Regulators Are Already Looking at the Same Question

The lawsuit lands while the government itself is examining the arrangement. In July 2026, CMS [issued a proposed rule](https://jrreport.wordandbrown.com/2026/08/11/cms-scrutinizes-amas-cpt-coding-system-seeks-public-input/) that sought public comment on “harms or challenges associated with the AMA's monopoly over CPT-4 licenses.” The agency cited long-standing concerns about the government relying on a private body that has a financial stake in how the codes are decided. The court case and the regulatory review are separate tracks, but both turn on the same tension between a public mandate and private control.

## A Win Would Clarify Your Bill, Not Lower It

Free CPT codes would not, by themselves, make your medical bill cheaper or fully transparent. A CPT code says what was done to you, not what it costs. The dollar figure on your bill comes from negotiated insurance rates and hospital chargemasters, which are governed by separate federal price-transparency rules that are already in force.

What freely available codes would change is understanding. Patients and researchers could look up the category of service billed without paying the AMA, and outside developers could publish the codes or build tools around them. That is a real gain for anyone trying to make sense of a bill or study billing patterns at scale, even if it is a narrower change than the word transparency suggests.

## FAQ

**Q: What is a CPT code?**
CPT stands for Current Procedural Terminology. Each code is a number that names a specific medical service or procedure. For example, 99213 identifies a standard office visit. The codes appear on medical bills and insurance claims to describe what care was provided.

**Q: Who owns CPT codes?**
The American Medical Association owns the CPT code set and holds the copyright to it. The AMA licenses the codes to providers, insurers, and others for a fee.

**Q: Are CPT codes required by law?**
Yes. CMS mandated CPT for Medicare Part B in 1983 and for Medicaid in 1986, and HHS adopted it under HIPAA as the national standard for electronic health transactions, codified at 45 CFR 162.1002. At least 45 states require its use.

**Q: Why does the AMA charge for CPT codes?**
The AMA says the licensing fees fund the continuous maintenance and annual updating of the code set through its CPT Editorial Panel, which adds and revises codes as medicine changes. The program brings in more than $300 million a year.

**Q: Would free CPT codes make my medical bill cheaper or clearer?**
Not on their own. A CPT code describes what service was performed, not its price. The amount you owe comes from negotiated insurance rates and hospital chargemasters, which fall under separate price-transparency rules. Free codes would help you understand the category of service billed and let others build tools around the codes, but they would not reveal or lower the price.