Wednesday, October 29, 2025

Senate Letter Criticizes the "AMA Monopoly" on the U.S. Coding System

October saw a sharply worded letter from Senator Cassidy to the AMA, criticizing the "monopoly" (his term) on the US main coding system.  That monopoly, though, was granted by Congress in the U.S. HIPAA law and subsequent CMS regulations, to ensure a uniform coding system for communications between providers and payers.   

click to enlarge


Sources:

  • Press release from Senator Cassidy, with full letter link (October 8).  Here. 
  • Report at Inside Health Policy (subscription).  Here.
  • At Modern Healthcare (subscription).  Here.
  • Article at MedPage Today.  Here.
  • Report at Fierce Healthcare.  Here.
  • At Medical Device Mfgrs Assoc.  Here.
  • At Politico Pro (subscription.)  "Cassidy and RFK Jr have something to disagree on."  Here.
Interestingly, for Medicare claims, MolDx could run genomic test transactions without the AMA.  A large part of MolDx services are coded as 81479, "other molecular test," and processed with the Z-code.  CMS could create a G code like - G1479 "other molecular test," which would not carry royalties with AMA.   Depending on the wording and the implementation, MolDx (CMS) might use it for 81479 claims only or all types of molecular tests (even with PLA or Category I codes).   This could pull several billion dollars a year of services coded with AMA CPT codes (including 81479) into one or two G codes which are royalty-free.


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AI CORNER
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Sen. Cassidy Challenges AMA’s CPT Monopoly, Launching Senate Review of Coding Fees

Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, has opened a formal inquiry into the American Medical Association’s (AMA) management of the Current Procedural Terminology (CPT) coding system—a cornerstone of U.S. healthcare billing. In a sharply worded October 6 letter to AMA President Bobby Mukkamala, Cassidy accused the AMA of “abusing its government-endorsed CPT monopoly” by charging “exorbitant fees” to physicians, hospitals, insurers, and health IT vendors. He argued that these costs are ultimately passed on to patients in the form of higher healthcare prices.

Cassidy’s letter cites the Health Insurance Portability and Accountability Act of 1996 (HIPAA), under which the federal government mandated CPT codes as the national standard for medical transactions. This legal framework effectively grants the AMA exclusive control over a coding system required by every payer and provider in the country. Cassidy noted that the AMA collected more than $500 million in revenue in 2024, over half of which came from publications and licensing of CPT-related content. He demanded detailed financial disclosure on how much of that income derived directly from CPT products, as well as a five-year record of price increases and related administrative costs.

The senator’s inquiry extends beyond financial transparency to the AMA’s policy positions. He questioned whether revenue from CPT licensing supports what he termed “anti-patient, anti-science advocacy,” citing AMA initiatives related to gender-affirming care and diversity, equity, and inclusion programs. Cassidy also criticized the AMA for representing only about a quarter of practicing physicians, despite controlling a process that affects all providers nationwide.

The AMA has acknowledged receipt of the letter and indicated it will respond. Meanwhile, healthcare commentators note that criticism of the AMA’s dominance over CPT codes is not new. UT Health’s Dr. Brant Mittler remarked that “the government giveth and the government can taketh away,” suggesting Congress could reconsider the AMA’s monopoly designation. With Cassidy’s review underway, the AMA’s long-standing control over medical billing codes faces one of its most direct challenges in decades.