Updated CPT codes face scrutiny over fees, politics, and control

Usually, the annual release of updated Current Procedural Terminology (CPT) codes from the American Medical Association (AMA) is met with little fanfare. Vendors announce that their medical devices, digital therapeutics, or technology-supported procedures are now covered by billing codes, stakeholders prepare for code updates, and everyone moves on. 

Not so this year. Shortly after the AMA released the 2026 CPT code set, with 288 new codes covering use cases from short-term remote monitoring to artificial intelligence (AI) services, the organization found itself facing scrutiny from Sen. Bill Cassidy, M.D., R-Louisiana. 

In a series of letters to the AMA summarized by Fierce Healthcare, Cassidy – chair of the Senate Health, Education, Labor and Pensions (HELP) Committee – criticized the AMA for charging “exorbitant” user fees for licensing CPT codes that he said contribute to higher healthcare costs. He gave the organization until Dec. 15 to respond to a series of questions about how new codes are determined and priced, as well as whether any AMA revenue supports gender-affirming services and diversity, equity, and inclusion initiatives. 

The critique of what the AMA may do with its money aligns with the Trump administration’s pushback against medical societies ‘advanc[ing] a political agenda,” as Cassidy put it. An October response from CEO John Whyte, M.D., noted AMA policies support diversity in medical education but don’t direct funding toward research of gender-affirming care.  

While Cassidy framed his call for greater CPT code revenue transparency in light of the AMA’s perceived ideology, he’s not alone in suggesting the organization charges too much for the use of CPT codes. 

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The AMA’s royalty rates for 2026 start at $82.50 per provider entity, plus $18.50 per user. For health plans, the royalty rate is $100, plus 24 cents per member; for labs, it’s $100 plus $0.0004167 per lab test.  

However, there are additional annual royalty fees that include an upfront fee of $1,050, a $13,000 fee to access CPT Link educational content, and fees for coding support programs such as the CPT Advanced Coding Pack ($195 per user), or the baseline CPT Assistant coding support tool ($143 per user). 

All told, this contributes to annual revenue for the AMA that exceeded $513 million in 2024, with more than $281 million coming from selling and licensing printed and digital coding resources. 

Last year, Samant Virk, M.D., CEO of practice management technology vendor MediSprout, similarly described AMA fees as “exorbitant” – especially since CPT codes are mandatory for processing claims and issuing payments. His frustration, he wrote in a blog post last year, is that “practices have no other option but to pay for a service that is essentially mandatory” but unavailable elsewhere. 

Virk and MedScape noted it hasn’t always been this way. The AMA first published CPT codes nearly 60 years ago, in the name of standardized medical documentation. In the 1980s, the Centers for Medicare & Medicaid Services adopted the codes for reporting purposes.  

It wasn’t until HIPAA became law in 1996 that CPT codes were deemed a national standard, at which point the organization formed an Editorial Panel to meet regularly and CPT code changes. Twelve medical specialist groups appoint seats on the 21-member panel. 

Virk suggested that CMS, which already manages International Classification of Diseases, version 10 (ICD-10) code lists, could be put in charge of administering CPT codes. Along with allowing for lower fees, this could contribute to simpler administrative processes by “consolidating the myriads of medical codes across the sector.” Given the statements from Cassidy and others on Capitol Hill, though, it remains to be seen if industry stakeholders would want government agencies to oversee CPT codes after all.   

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.