{"id":15415,"date":"2025-10-09T10:50:47","date_gmt":"2025-10-09T10:50:47","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=15415"},"modified":"2025-10-09T10:50:47","modified_gmt":"2025-10-09T10:50:47","slug":"senator-challenges-amas","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/","title":{"rendered":"Senator Challenges AMA&#8217;s Medical Billing Code Control"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_75 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#Senator_Cassidy_Launches_Investigation_into_CPT_Codes\" >Senator Cassidy Launches Investigation into CPT Codes<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#The_AMAs_Role_in_Medical_Billing\" >The AMA&#8217;s Role in Medical Billing<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#Financial_Transparency_Concerns\" >Financial Transparency Concerns<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#The_Government-Backed_Monopoly_Question\" >The Government-Backed Monopoly Question<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#How_CPT_Codes_Are_Updated\" >How CPT Codes Are Updated<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#Broader_Healthcare_Policy_Implications\" >Broader Healthcare Policy Implications<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/#What_This_Means_for_Patients_and_Providers\" >What This Means for Patients and Providers<\/a><\/li><\/ul><\/nav><\/div>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"Senator_Cassidy_Launches_Investigation_into_CPT_Codes\"><\/span>Senator Cassidy Launches Investigation into CPT Codes<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\"><strong>Senator Bill Cassidy, M.D., R-Louisiana<\/strong>, chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, has initiated a comprehensive investigation into the <strong>American Medical Association&#8217;s<\/strong> management of the healthcare system&#8217;s critical <strong>Current Procedural Terminology (CPT) coding system<\/strong>. The senator&#8217;s inquiry focuses on what he characterizes as &#8220;anti-patient and anti-doctor&#8221; practices that may be driving up healthcare costs across the nation.<\/p>\n<p class=\"whitespace-normal break-words\">In a strongly worded letter sent Monday and released publicly Wednesday, <strong>Senator Cassidy<\/strong> accused the <strong>AMA<\/strong> of &#8220;abusing&#8221; its position as the custodian of the <strong>CPT code set<\/strong> that virtually every healthcare entity in America uses for billing and claims processing. The investigation marks a significant escalation in congressional oversight of medical billing practices and raises fundamental questions about the cost structure of American healthcare.<\/p>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"The_AMAs_Role_in_Medical_Billing\"><\/span>The AMA&#8217;s Role in Medical Billing<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\">The <strong>CPT coding system<\/strong> serves as the backbone of medical billing in the United States, with <strong>more than 11,000 codes<\/strong> currently in use. For approximately half a century, the <strong>AMA<\/strong> has maintained trademark rights and curatorial responsibilities for these codes, which are used by doctors, hospitals, health insurance plans, and health IT vendors nationwide.<\/p>\n<p class=\"whitespace-normal break-words\"><strong>Senator Cassidy&#8217;s letter<\/strong> specifically challenged the <strong>AMA&#8217;s practice of charging fees<\/strong> to anyone utilizing the <strong>CPT code set<\/strong>. According to the senator, &#8220;These fees inevitably are passed on by CPT users to patients in the form of higher healthcare costs.&#8221; This arrangement has created what critics describe as a profit center built into the fundamental infrastructure of American healthcare billing.<\/p>\n<p class=\"whitespace-normal break-words\">The widespread adoption of <strong>CPT codes<\/strong> wasn&#8217;t entirely voluntary. The <a href=\"https:\/\/www.cdc.gov\/phlp\/php\/resources\/health-insurance-portability-and-accountability-act-of-1996-hipaa.html\" target=\"_blank\" rel=\"noopener\"><strong>Health Insurance Portability and Accountability Act of 1996 (HIPAA)<\/strong> <\/a>mandated the use of a standard code set, effectively cementing the <strong>AMA&#8217;s<\/strong> position as the sole provider of this essential healthcare tool. This federal requirement is central to <strong>Senator Cassidy&#8217;s<\/strong> characterization of the arrangement as a <strong>&#8220;government-backed monopoly.&#8221;<\/strong><\/p>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"Financial_Transparency_Concerns\"><\/span>Financial Transparency Concerns<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\">A major component of <strong>Senator Cassidy&#8217;s investigation<\/strong> involves demanding detailed financial disclosure from the <strong>AMA<\/strong> regarding its <strong>CPT-related revenues<\/strong>. The senator specifically requested information about how much of the organization&#8217;s substantial <strong>$513.2 million total 2024 revenue<\/strong> came from the sale and licensing of <strong>CPT coding materials<\/strong>.<\/p>\n<p class=\"whitespace-normal break-words\">The inquiry also targets the <strong>AMA&#8217;s<\/strong> reported <strong>$281.4 million<\/strong> in &#8220;books and digital content&#8221; revenue, seeking clarification on what portion derives from <strong>CPT code<\/strong> subscriptions and related online resources. <strong>Senator Cassidy<\/strong> has asked the <strong>AMA<\/strong> to provide:<\/p>\n<ul class=\"[&amp;:not(:last-child)_ul]:pb-1 [&amp;:not(:last-child)_ol]:pb-1 list-disc space-y-1.5 pl-7\">\n<li class=\"whitespace-normal break-words\"><strong>Detailed breakdowns<\/strong> of revenue sources related to CPT materials<\/li>\n<li class=\"whitespace-normal break-words\"><strong>Pricing methodology<\/strong> for CPT code subscriptions and resources<\/li>\n<li class=\"whitespace-normal break-words\"><strong>Five-year historical data<\/strong> on price changes and associated revenues<\/li>\n<li class=\"whitespace-normal break-words\"><strong>Information on cost structures<\/strong> and profit margins<\/li>\n<\/ul>\n<p class=\"whitespace-normal break-words\">These requests aim to establish whether the <strong>AMA<\/strong> is leveraging its unique position to generate excessive profits from a system that healthcare providers must use by regulatory requirement.<\/p>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"The_Government-Backed_Monopoly_Question\"><\/span>The Government-Backed Monopoly Question<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\">The concept of a <strong>&#8220;government-backed monopoly&#8221;<\/strong> lies at the heart of <strong>Senator Cassidy&#8217;s concerns<\/strong>. Because the <strong>Centers for Medicare and Medicaid Services (CMS)<\/strong> and virtually all health insurance payment systems require the use of <strong>CPT codes<\/strong>, healthcare providers have no alternative but to license these codes from the <strong>AMA<\/strong>.<\/p>\n<p class=\"whitespace-normal break-words\">This creates a unique market situation where demand is guaranteed by regulatory mandate, yet supply is controlled by a single private organization. <strong>Senator Cassidy<\/strong> argues this arrangement may allow the <strong>AMA<\/strong> to set prices without typical market constraints, effectively creating a tax on healthcare transactions that ultimately burdens patients.<\/p>\n<p class=\"whitespace-normal break-words\">The <strong>AMA<\/strong> has defended its position by arguing that its status as the nation&#8217;s largest physician association makes it &#8220;uniquely positioned&#8221; to coordinate changes to a uniform code set necessary for large-scale medical service information exchange. The organization maintains that centralized management ensures consistency and interoperability across the healthcare system.<\/p>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"How_CPT_Codes_Are_Updated\"><\/span>How CPT Codes Are Updated<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\">Understanding the <strong>CPT code update process<\/strong> is crucial to evaluating the <strong>AMA&#8217;s<\/strong> stewardship of the system. The organization convenes a <strong>21-member independent CPT Editorial Panel<\/strong> that meets three times annually to review applications for new or revised codes.<\/p>\n<p class=\"whitespace-normal break-words\">According to the <strong>AMA&#8217;s<\/strong> website, this process includes &#8220;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.&#8221; <strong>Senator Cassidy<\/strong> has specifically requested details about how provider feedback is incorporated into final code decisions.<\/p>\n<p class=\"whitespace-normal break-words\">The <strong>CPT 2026 code set<\/strong>, released last month, included <strong>418 total code changes<\/strong>: 84 deletions, 46 revisions, and 288 additions. These new codes address emerging healthcare technologies, including <strong>augmentative and assistive AI services<\/strong> and <strong>technology-fueled remote monitoring<\/strong> capabilities.<\/p>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"Broader_Healthcare_Policy_Implications\"><\/span>Broader Healthcare Policy Implications<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\"><strong>Senator Cassidy&#8217;s letter<\/strong> extended beyond financial concerns to address what he termed the <strong>AMA&#8217;s &#8220;anti-patient, anti-science advocacy efforts.&#8221;<\/strong> The senator reiterated Republican and Trump administration grievances regarding the <strong>AMA&#8217;s<\/strong> stated support for <strong>gender-affirming services<\/strong> and adoption of <strong>diversity, equity, and inclusion (DEI)<\/strong> initiatives.<\/p>\n<p class=\"whitespace-normal break-words\">The senator requested specific information about how much the <strong>AMA<\/strong> spent on these advocacy areas in 2024, arguing that reviewing <strong>CPT code-related revenues<\/strong> is &#8220;especially&#8221; pertinent in light of this advocacy work. This represents a continuation of concerns <strong>Senator Cassidy<\/strong> raised in a separate letter sent in late September, where he accused the association of being &#8220;guided by ideological views in adopting policy resolutions, rather than doing what is right for doctors and patients.&#8221;<\/p>\n<h2 class=\"text-xl font-bold text-text-100 mt-1 -mb-0.5\"><span class=\"ez-toc-section\" id=\"What_This_Means_for_Patients_and_Providers\"><\/span>What This Means for Patients and Providers<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p class=\"whitespace-normal break-words\">The investigation&#8217;s implications extend far beyond Washington politics. If <strong>Senator Cassidy&#8217;s<\/strong> concerns prove valid, the <strong>CPT code licensing fees<\/strong> charged by the <strong>AMA<\/strong> may represent a hidden cost driver in American healthcare, adding expense to every medical transaction without providing corresponding value to patients.<\/p>\n<p class=\"whitespace-normal break-words\">For healthcare providers, the investigation raises questions about whether they&#8217;re paying unnecessarily high fees for access to codes they&#8217;re required by law to use. For patients, the concern is whether these costs are being passed through in the form of higher medical bills and insurance premiums.<\/p>\n<p class=\"whitespace-normal break-words\">The <strong>AMA<\/strong> has confirmed receipt of <strong>Senator Cassidy&#8217;s letter<\/strong> and stated it will respond, though no timeline was provided. As this investigation unfolds, it may prompt broader discussions about how essential healthcare infrastructure should be managed and whether private organizations should maintain monopolistic control over systems mandated by federal law.<\/p>\n<p>Discover the latest\u00a0<a href=\"https:\/\/distilinfo.com\/healthplan\/\"><strong>payers\u2019 news updates<\/strong><\/a>\u00a0with a single click. Follow\u00a0<a href=\"https:\/\/distilinfo.com\/healthplan\/\">DistilINFO HealthPlan<\/a>\u00a0and stay ahead with updates. Join our community today!<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Senator Cassidy Launches Investigation into CPT Codes Senator Bill Cassidy, M.D., R-Louisiana, chairman of the Senate Health, Education, Labor and&#8230; <a href=\"https:\/\/distilinfo.com\/healthplan\/senator-challenges-amas\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":15416,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[461,4183,4180,3053,40,4174,4181,4175,4178,87,110,1406,567,688,4176,330,4182,4177,4179,4173],"class_list":{"0":"post-15415","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-ama","9":"tag-ama-investigation","10":"tag-billing-codes","11":"tag-centers-for-medicare-medicaid-services","12":"tag-cms","13":"tag-cpt-codes","14":"tag-cpt-editorial-panel","15":"tag-current-procedural-terminology","16":"tag-government-backed-monopoly","17":"tag-health-insurance","18":"tag-healthcare-costs","19":"tag-healthcare-policy","20":"tag-healthcare-reform","21":"tag-healthcare-transparency","22":"tag-help-committee","23":"tag-medical-billing","24":"tag-medical-coding-fees","25":"tag-medical-coding-system","26":"tag-physician-association","27":"tag-senator-bill-cassidy","28":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/15415"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=15415"}],"version-history":[{"count":1,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/15415\/revisions"}],"predecessor-version":[{"id":15417,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/15415\/revisions\/15417"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/15416"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=15415"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=15415"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=15415"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}