Senate Health, Education, Labor and Pensions (HELP) Committee Chair Bill Cassidy, M.D., is doubling down on his scrutiny of the American Medical Association's (AMA's) handling of billing and claims processing codes, telling the professional organization this week that it dodged several of the questions he posed on pricing and other topics back in October.
The senator, a Republican from Louisiana and Congress' most prominent healthcare legislator, has been putting the screws on the professional association for, in his words, "abusing" its widely adopted Current Procedural Terminology (CPT) coding system with "exorbitant fees" that drive higher healthcare costs.
He sought information on how the AMA determines new codes, pricing for use of the codes and other supplementary material, and how the organization may be using those revenues to support other activities including diversity, equity and inclusion (DEI) policies or gender-affirming care.
(Editor's note: See the story on October's information requests below the break.)
Cassidy published on Tuesday a copy of the AMA's response letter, which the senator told the AMA in a new missive "did not answer my questions that could assuage [my] concern." He reiterated most of these in the new letter, as well as some others prompted by the association's response.
"I am concerned that the status quo focuses on enriching the AMA at the expense of patients, while the organization subsequently uses the revenue to advance a political agenda that is not representative of the majority of the medical community,” Cassidy wrote in reference to DEI and gender-affirming care. “...If you are unable to voluntarily reply in a fulsome and timely manner, the Committee will consider other options to secure the information requested from the AMA.”
The AMA's two-page response (PDF) to Cassidy's initial questions, penned in late October by CEO John Whyte, M.D., described in broad terms the organization's CPT Editorial Panel. More than half of the 21-member body is appointed by other national medical specialty organizations, and several spots are held by payer representatives while government bodies have non-voting liaisons, Whyte explained. The panel considers direct input from other stakeholders, and its agendas, several associated materials and action summaries are available either by application or through public posting, he said.
As for the CPT fees, Whyte said AMA "respectfully disagree[s]" with Cassidy's characterization of "exorbitant fees," and outlined a $18.50 per user per year license fee in 2025 as well as health plans' $0.24 per member per year licenses.
On the use of AMA funds, Whyte acknowledged that the AMA House of Delegates had adopted policies in support of diversity in medical education, but said "the AMA did not directly spend any funds supporting such policy mandates nor was any funding used supporting research on gender transition care."
Cassidy's new letter (PDF) sought more specificity on how AMA incorporates feedback from nonmembers, and a granular breakdown in the costs and revenues tied to CPT codes and related materials.
Further, writing that the "the limited information provided in your letter raises additional questions about the AMA’s commitment to improving care," Cassidy added new questions on the CPT Editorial Panel's processes while noting that the published summaries of its actions "provide limited information ... due to extensive confidentiality requirements imposed on [Interested Parties]."
On pricing, Cassidy noted that the fees described by Whyte are accompanied by a $1,050 upfront annual royalty fee and other charges tied to supplementary products, and asked for information on how the fees are calculated and used.
Finally, the senator sought more information on the extent to which the AMA House of Delegates influences the association's partnerships and advocacy specific to DEI and gender-affirming care. He also asked whether AMA's membership feeds fund the House of Delegates' activities, and whether AMA members are given the option of opting out of supporting advocacy activities.
Cassidy gave the AMA a deadline of Dec. 15 to voluntarily respond to the updated inquiries. The AMA, in a statement to the Washington Post, said it planned to respond to the requests.
Oct. 8, 2025
American Medical Association's handling of CPT codes enters Congress' crosshairs
The top senator on healthcare policy is taking a hard look at the American Medical Association’s “anti-patient and anti-doctor” handling of the healthcare system’s near-ubiquitous billing and claims processing codes.
Bill Cassidy, M.D., R-Louisiana, who chairs the Senate Health, Education, Labor and Pensions (HELP) Committee, chastised the nation’s leading physician association for “abusing” the Current Procedural Terminology (CPT) coding system and said he will be “actively reviewing” the issue.
In a letter sent Monday but made public Wednesday, he accused the AMA of “charging exorbitant fees to anyone using the CPT code set, including doctors, hospitals, health plans and health IT vendors. These fees inevitably are passed on by CPT users to patients in the form of higher healthcare costs.”
The letter includes requests for the AMA to detail how it incorporates provider feedback into its process for finalizing codes, and for specific details on revenues and spending related to CPT codes.
Specifically, he asked AMA how much of its $513.2 million total 2024 revenue, or its $281.4 million of “books and digital content,” stemmed from the sale and licensing of CPT coding materials, which could include subscriptions the organization sells for online resources related to the codes. The senator further requested information on how AMA calculates the for-sale price of those materials, and a five-year lookback on price changes and related revenues.
Cassidy’s letter also reiterated grievances Republicans and the Trump administration hold against medical associations over their stated support of gender-affirming services as appropriate care, as well as the group’s adoption of initiatives related to diversity, equity and inclusion—which the senator referred to as “AMA’s anti-patient, anti-science advocacy efforts.” He requested information on how much the AMA had spent on these areas in 2024.
Cassidy had penned a separate letter to the AMA on these subjects in late September, accusing the association of being “guided by ideological views in adopting policy resolutions, rather than doing what is right for doctors and patients.” Reviewing the AMA’s handling of CPT code-related revenues is “especially” pertinent in light of that advocacy, the senator said in this week’s letter.
"The AMA received Sen. Cassidy’s letter, and we will respond," the association told Fierce Healthcare when reached for a statement..
There are more than 11,000 codes in the current CPT code set, which has been trademarked and curated by the AMA for about half a century. Nearly all health insurance payment and information systems use the codes, including the Centers for Medicare and Medicaid Services. Use of a standard code set was mandated by the federal government under the Health Insurance Portability and Accountability Act of 1996, Cassidy’s letter notes, playing a role in the AMA’s “government-backed monopoly.”
To update its codes, the AMA convenes a 21-member independent CPT Editorial Panel that meets three times a year to review applications for new or revised codes. The panel’s process includes “the direct input of practicing physicians, medical device manufacturers, developers of the latest diagnostic tests, and advisors from over 100 societies representing physicians and other qualified health care professionals,” according to the association’s website.
The organization has said its role as the nation’s largest physician association makes it “uniquely positioned” to coordinate changes to a uniform set of codes necessary to enable large-scale medical service information exchange.
AMA released its CPT 2026 code set last month, with 418 total code changes including, 84 deletions, 46 revisions and 288 additions. The new codes address, among other areas, augmentative and assistive AI services and technology-fueled remote monitoring.