The AMA Must Defend its Paywall on CPT Codes

On August 12, 2026, a legal action was filed, called PatientRightsAdvocate.org, Inc. v. American Medical Association (N.D. Ill.). Declaratory Judgment Action re: Copyrightability of CPT Codes. In my view, this case has deep public policy implications.

Once, many years ago, I helped a client in the health care software business negotiate a license for the use of Current Procedural Terminology (CPT) codes. I had never heard of CPT codes before that time. What I learned during that negotiation left me amazed and dismayed, and now, over a decade later, I am pleased to see that an advocacy organization has brought a legal action to remedy the situation.

PatientRightsAdvocate.org, Inc. (PRA), a nonprofit healthcare-transparency advocate, filed a declaratory judgment action to confirm that it may freely publish the CPT codes on its website without liability for copyright infringement. The case is a Declaratory Judgment (DJ) action–not asking for damages for a plaintiff as in a typical lawsuit, but asking the court to make a statement of the absence of liability, on behalf of the party filing the action (and is at risk as a defendant in a potential lawsuit). The DJ action has asked the court to confirm that (1) CPT is not copyrightable, (2) even if it is protected by copyright, posting it would be fair use, and (3) the AMA’s copyright, even if valid, is unenforceable due to copyright misuse.

CPT’s Liberation Matters To Everyone in the US

CPT is a set of five-digit codes and descriptions that the AMA has published since 1966 to classify medical procedures and services. The AMA revises CPT annually, asserting a new copyright in each annual revision, and sells access to it. The access fees are significant. A physical copy costs about $140, and end-user license agreements for electronic use (such as in software) require royalties on a per-user or per-member basis. For a moderately sized health technology business, this can run to hundreds of thousands, if not millions, of dollars. In 2025, the AMA reported $296.4 million in revenue from books and digital content, netting $267.5 million in profit–apparently largely from licensing CPT.

Consider that a moment: over a quarter of a billion a year for licensing codes. Nice work if you can get it, but no one should be able to get it.

The problem is that healthcare businesses are required by law to use CPT codes. In 1977, Congress directed the predecessor of the Centers for Medicare & Medicaid Services (CMS) to create a uniform medical procedure coding system, which led to the creation of CPT. According to the DJ action, a 1983 license agreement requires the government to adopt and use CPT for Medicare and Medicaid and to publicly endorse it, while the AMA controls the editorial panel that revises the codes. That means every medicare claim must be coded with CPT codes.

HHS regulations implementing HIPAA designate CPT as the mandatory code set for electronic healthcare billing transactions. 42 U.S.C. §1320d-2(c). According to the DJ action, at least 45 states also require the use of CPT via their own regulations, and at least 15 expressly incorporate it by reference into their administrative codes.

The AMA is primarily a lobbying organization. The AMA has donated between $1.6 million and $3.4 million in election cycles between 1990 and 2020. According to the logic in the DJ action, most of that money comes from licensing CPT codes.

The DJ Action’s Claims

PRA contends that because CPT has been hard-coded (pun intended) into federal and state law, and because CMS historically held a voting seat on the AMA’s CPT Editorial Panel, the CPT set falls outside copyright protection under the “government edicts” doctrine–under which the text of laws are not protected by copyright. This, in turn, is based on the idea that access to the text of the law should be available to everyone.

The AMA, for its part, has long defended CPT as its private intellectual property — including an amicus brief in ASTM v. UpCodes, Inc. (3d Cir. 2026) arguing incorporation into law does not defeat copyright and that posting such codes online is not fair use.

What is a CPT Code?

Here are some examples, so you can assess the copyrightibility of this work of authorship on your own. Remember that copyright law protects expression, not facts.

And by the way, my friendly AI refused to pull examples for me, because they are paywalled. So the following examples are not precisely CPT codes: they are HCPCS Level II codes. The distinction between CPT codes and HCPCS codes, however, is subject matter, not form. The CPT consists of codes for what physicians and clinicians do, and the HCPCS codes are codes for ancillary products and services (such as supplies, equipment, ambulance transport, and non-physician services). Together, the two make up the full HCPCS system CMS requires for Medicare and Medicaid billing.

1. A0425 — Ground mileage, per statute mile
2. A0428 — Ambulance service, basic life support, non-emergency transport (BLS)
3. E0114 — Crutches, underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips
4. E1130 — Standard wheelchair, fixed full length arms, fixed or swing away detachable footrests
5. G0008 — Administration of influenza virus vaccine
6. J1885 — Injection, ketorolac tromethamine, per 15 mg
7. Q0091 — Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory

Ah, the beauty and expressiveness of this work of authorship overwhelms me! What poet came up with “Administration of influenza virus vaccine”?

This is factual material and deserves no copyright protection at all. And to the extent it might, the fact that these codes are legally mandated for use–as factual material–should mean, as a matter of policy, there can be no liability for copying them.

Why This Matters

So to be clear: Your healthcare providers are required by the government to use CPT codes. They pay high royalties to the AMA to do so. The AMA uses that money to fund campaigns and gain influence with the government.

It’s time to end this vicious circle. Good luck to the plaintiff here.