American Medical Association CPT Code Controversy Sparks Senate Investigation
The American Medical Association CPT code controversy is gaining national attention as Congress questions the organization’s influence over healthcare billing. The chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, Senator Bill Cassidy, M.D. (R-Louisiana), has accused the American Medical Association (AMA) of “abusing” its control of the Current Procedural Terminology (CPT) system, claiming it to be anti-patient and anti-doctor.
In a letter made public this week, Cassidy said he will be “actively reviewing” how the AMA manages and profits from the CPT coding system that underpins nearly every medical billing and insurance claim in the United States.
Senator Cassidy Questions AMA’s Control Over CPT Codes
The center of the American Medical Association CPT code controversy is the senator’s concern about “excessive fees” charged to anyone using the CPT system, which includes hospitals, doctors, insurers, and even health IT vendors. According to Cassidy, those fees inevitably trickle down to patients, increasing overall healthcare costs.
He requested the AMA to provide detailed financial disclosures, including how much of its $513.2 million total 2024 revenue, and $281.4 million in books and digital content came from the sale and licensing of CPT-related materials. Cassidy also requested a five-year record of pricing changes and revenues related to these materials to assess the organization’s transparency and accountability.
Concerns About a Government-Backed Monopoly
This controversy also raises questions about fairness and competition. The CPT code set has been trademarked by the AMA for over 50 years and is now a required system under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Almost all of U.S. healthcare providers, insurers, and government programs, including Medicare and Medicaid, rely on this code set for billing and reporting.
Cassidy described the AMA’s position as a “government-backed monopoly,” noting that its control over the coding process gives it unique financial power within the healthcare system.
He further raised broader concerns about the AMA’s policy direction, quoting “anti-science advocacy efforts” and the group’s stance on diversity and inclusion as examples of misplaced priorities.
AMA Defends Its Role in Healthcare Coding
The American Medical Association responded to Cassidy’s letter by stating, “The AMA received Sen. Cassidy’s letter, and we will respond.”
The organization believes that its size and expertise position it to manage coding updates responsibly. Its CPT Editorial Panel is composed of 21 independent members, including physicians, device manufacturers, and representatives from more than 100 medical societies, and meets three times per year to review requests for new or revised codes.
The AMA argues that this collaborative approach ensures CPT codes accurately reflect modern medical practice and support efficient communication across the healthcare system.
CPT 2026 Code Set Highlights Emerging Medical Technologies
During the controversy, the organization released its CPT 2026 code set, which includes 418 total changes: 288 new codes, 46 revisions, and 84 deletions. Many of the new codes address growing fields like artificial intelligence in diagnostics, assistive technologies, and remote patient monitoring, showing the CPT system’s ongoing adaptation to digital healthcare trends.
Critics, however, argue that these advancements do not address the underlying issue, which is the financial model that places control and profit from essential billing codes in the hands of one private organization.
Final Takeaway
The American Medical Association CPT code controversy highlights a growing debate over transparency, accountability, and control in healthcare. With digital health and AI reshaping how medical services are delivered, lawmakers are questioning whether one association should continue to hold the keys to the system that defines and prices nearly every medical service in America.
