The Trump administration is formally questioning the American Medical Association's decades-long lock on the medical billing codes every doctor, hospital, and insurer in the country is forced to use, a system critics say has quietly generated more than half a billion dollars a year for a single private organization.
The Centers for Medicare and Medicaid Services published a proposed rule on July 16 that, among other provisions, asks the public to weigh in on what CMS calls the AMA's "monopoly" over the Current Procedural Terminology code set, the standardized list of numeric codes that providers must use to bill Medicare, Medicaid, and most private insurers for medical services. The rule, part of the agency's calendar year 2027 Physician Fee Schedule package, frames the request as a priority under the administration's "Make America Healthy Again" agenda.
The proposed rule does not hold back. CMS asks directly: "What, if any, evidence is there for CMS to consider regarding the harms or challenges associated with AMA's monopoly over CPT-4 licenses for health care entities?" That a federal agency is using the word "monopoly" in an official regulatory document, about an organization that represents physicians, signals that the administration views the AMA's billing code empire as a genuine policy problem, not a bureaucratic footnote.
The AMA's own 2024 annual report disclosed $513.2 million in total revenue, up from $495.1 million the year before. Sen. Bill Cassidy, the Louisiana Republican who chairs the Senate Health, Education, Labor, and Pensions Committee, wrote in an October 2025 letter to the AMA that more than half of that revenue came from publishing books and digital content, including the annual CPT code publications that every provider in the country must purchase to bill for services.
The revenue trajectory is steep. The AMA's total royalty income surged from $65.8 million in 2011 to $284.8 million in 2023, a more than fourfold increase in just over a decade. It remains unclear exactly how much of the AMA's annual haul comes specifically from CPT licensing, but the growth curve alone raises questions about whether a private trade group should hold this kind of leverage over the payment infrastructure of American medicine.
Cassidy's letter accused the AMA of abusing its position. He wrote that the organization "has abused this government-backed monopoly by charging exorbitant fees to anyone using the CPT code set, including doctors, hospitals, health plans, and health IT vendors." He said he was "particularly offended" by the AMA "abusing its government-endorsed CPT monopoly to charge every stakeholder in the health care system significant amounts of money while advancing an anti-patient agenda."
The AMA did not respond to a request for comment.
Fred McGrath, executive director of the Institute for Legislative Analysis' Center for Healthcare Affordability, told the Daily Caller News Foundation that the arrangement traces back to a single piece of legislation. HIPAA, the Health Insurance Portability and Accountability Act of 1996, best known to most Americans as the law that governs medical privacy, also designated specific code sets for use across the healthcare system. McGrath argued that this effectively handed the AMA, a private organization, the power to force every insurer, provider, supplier, and government entity to use its proprietary codes.
McGrath called the arrangement "a textbook case of regulatory capture":
"The Health Insurance Portability and Accountability Act of 1996 effectively gave the AMA, a private entity, the power to force healthcare insurers, providers, suppliers, and government entities to use its codes. As one would expect when an organization is granted monopoly power, the AMA has used that position to generate more than $500 million in annual revenue."
That framing, a private group wielding government-granted power to extract fees from every corner of the healthcare system, is exactly the kind of cozy institutional arrangement that the Trump administration has targeted across multiple federal domains. CMS's proposed rule echoes the concern, citing a "longstanding concern expressed over the Federal reliance on a private organization with such an obvious conflict of interest as providing information on the time and resource requirements to conduct physician services when this information may influence their own payment."
In plain English: the AMA helps set the codes that determine how much doctors get paid, and then profits from licensing those same codes. The agency is now asking whether that arrangement has warped the entire payment system.
Cassidy's October 2025 letter laid out the timeline bluntly. CPT codes, he wrote, "are required to be used by providers to bill for services, and the AMA has had an exclusive monopoly on publishing these codes for over 40 years." No competitor publishes an alternative. No federal agency has stepped in to create a public-domain substitute. Providers pay the AMA's price or they cannot bill.
Rep. Diana Harshbarger, a Tennessee Republican and licensed pharmacist, has pushed the issue from the House side. In a statement, Harshbarger drew on her three decades in pharmacy:
"As a pharmacist for more than 30 years, I've seen how government-protected monopolies can drive up costs, stifle innovation, and ultimately leave patients paying the price. The Current Procedural Terminology (CPT) code set has become essential healthcare infrastructure, yet it remains controlled by a single private organization that faces no meaningful competition. When one organization controls the coding system used throughout Medicare and much of the entire healthcare system, that's a problem."
Harshbarger called on Congress to "bring transparency, competition, and accountability to this process so providers, innovators, and patients all benefit from a more open and competitive system." On June 12, she posted on X that the AMA "use[s] that monopoly to generate millions in licensing fees which they use to lobby Congress & protect the monopoly. Patients foot the bill for ALL of it."
Cassidy posted his own message on X on July 15, the day before the CMS rule dropped: "The AMA benefits from a government-backed CPT monopoly to collect licensing fees across the health care industry. This drives up costs for patients and families. I've been investigating it. The Trump administration is right to scrutinize." The coordination between congressional Republicans and the executive branch on this issue is hard to miss.
Beyond the money, CMS's proposed rule raises a structural argument. The agency describes the "historic reliance on the CPT and [RVS Update Committee] process", the RUC is an AMA-organized panel that recommends how Medicare values different medical services, as "a potential contributor to the development of US health care as a 'sick care' system with limited emphasis on prevention and lifestyle modifications."
That language connects the billing code fight to the broader "Make America Healthy Again" push led by HHS Secretary Robert F. Kennedy Jr. The administration's argument is that a coding system designed and maintained by a private physicians' group naturally favors procedures and treatments over prevention, because procedures generate revenue for the doctors the AMA represents. Whether that claim holds up under public comment remains to be seen, but the administration is putting the question on the record.
The AMA's relationship with the current administration is already strained. Multiple anonymous AMA doctors told Politico in June that the organization has become increasingly agitated with Kennedy. The billing code scrutiny adds another front to that tension, and unlike Kennedy's broader health agenda, the CPT issue has bipartisan roots and a paper trail stretching back decades.
McGrath added a political dimension to his critique. He noted that "the greater concern is that the AMA is a highly politicized entity that has pledged to 'infuse racial equity and social justice into the fabric of AMA's culture, systems, policies, and practices.'" For conservatives, the combination of monopoly power and ideological activism makes the AMA a particularly ripe target. A private group that forces every hospital in America to buy its product while simultaneously pushing a progressive social agenda is difficult to defend on free-market grounds.
The pattern fits a broader trend in which federal authorities have moved aggressively on healthcare billing and fraud. But the AMA's CPT arrangement is not a criminal matter, it is a structural one, embedded in federal law and regulation for nearly three decades. Unwinding it, or even introducing competition, would require either congressional action or a sustained regulatory push.
The CMS proposed rule is exactly that, proposed. It requests public comment, not immediate action. The agency has not announced plans to create an alternative coding system or to strip the AMA's designation. Congress has not introduced legislation to open CPT codes to competition, though Harshbarger and Cassidy have both signaled interest.
Cassidy's office did not respond to a request for comment from the Daily Caller News Foundation. The AMA also declined to respond. The silence from both sides leaves open the question of what, if anything, comes after the comment period closes.
But the fact that CMS used the word "monopoly" in an official proposed rule, and that the administration framed the AMA's coding system as a barrier to its health policy agenda, suggests this is more than a routine regulatory housekeeping exercise. The administration has shown willingness to use federal levers to pry open arrangements that previous administrations left untouched.
For decades, the AMA collected its fees, published its codes, and lobbied to keep the arrangement intact. Patients, providers, and taxpayers paid without knowing they had no choice. Now, for the first time, the federal government is asking out loud whether that deal ever made sense, and whether the people footing the bill deserve a say in how it works.
When a private organization can force an entire industry to buy its product by federal mandate, that is not a market. It is a toll booth. And Washington's appetite for challenging entrenched arrangements may finally have caught up with the AMA's longest-running revenue stream.
