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.