The American Medical Association presents itself as the unified voice of doctors across the country. In reality, it operates more like a lobbying machine than a professional society devoted to patient care. Behind the polished image is a government-backed monopoly on billing codes that brings in hundreds of millions of dollars each year by controlling one of the most essential tools in the healthcare system.
Current Procedural Terminology codes, or CPT codes, are the standardized codes that doctors use to bill for nearly every medical service. Whether a physician performs a checkup, writes a prescription, or orders a diagnostic test, the service must be recorded with one of these codes. Every hospital, insurance company, and medical provider must use them to get reimbursed. And every one of them is required to pay the AMA for access.
The AMA owns the copyright to these codes. Anyone who uses or displays them must pay licensing fees. This includes not only insurance companies and hospitals but also the doctors the AMA claims to represent.
In 2023 alone, CPT royalties generated almost $285 million for the AMA, accounting for more than half of the $468 million in total revenue the organization reported that year. That’s not a revenue stream; that’s a river. And it makes the AMA, according to watchdogs, “one of the most financially powerful nonprofits in American healthcare.”
This control did not happen by accident. In the 1980s, the Centers for Medicare and Medicaid Services began requiring CPT codes for services billed under Medicare and Medicaid. When HIPAA passed in 1996, the codes were formally adopted as the national standard for electronic health records. In 2000, the Department of Health and Human Services finalized a rule requiring these codes for all medical billing. Through a series of regulatory decisions, the federal government handed a private nonprofit exclusive control over an essential tool used by the entire healthcare industry.
The AMA has used this windfall to grow its political influence. Rather than return the money to doctors or use it to improve care, the organization invests heavily in lobbying. In 2024, the AMA spent almost 25 million dollars to influence lawmakers in Washington. That level of spending puts it in the top ten of major advocacy groups. At one point last year, the AMA had 67 lobbyists working on its behalf. This is not the behavior of a neutral medical association. It is the strategy of a political force.
This arrangement does not need to continue. The federal government has the resources and expertise to manage CPT codes on its own. The Centers for Medicare and Medicaid Services already handle vast amounts of health data. They could oversee the maintenance and distribution of billing codes as a public good. Removing the AMA from this role would lower costs, reduce conflicts of interest, and bring more transparency to an essential part of the healthcare system.
Doctors would benefit from this change. They already face overwhelming administrative demands and rising costs. Forcing them to pay into a system that funds a lobbying operation they may not support only adds to their burden. Patients would benefit as well. A more open and accountable billing system would improve efficiency and reduce unnecessary overhead.
This reform would not require a new law. It could be achieved through executive action by the Secretary of Health and Human Services. With support from the White House, CPT codes could be placed in the public domain. That step would end the royalty structure and strip away the financial engine behind the AMA’s political machine.
The AMA can still play a role in healthcare, but it should not serve as the gatekeeper to the billing system that doctors and patients rely on every day. A private lobbying group should not profit from government-imposed mandates. Let doctors focus on caring for patients, not supporting a revenue stream that feeds a political machine. It is time to return control of this critical system to the public.
Jason Altmire is an adjunct professor of healthcare management at the Texas Tech University Health Sciences Center. He has been an executive in both the hospital and health insurance industries, and from 2007 to 2013 served three terms in the U.S. House of Representatives.
Jason Altmire is an adjunct professor of healthcare management at the Texas Tech University Health Sciences Center. He has been an executive in both the hospital and health insurance industries, and from 2007 to 2013 served three terms in the U.S. House of Representatives.
