Senator Cassidy Challenges AMA Over CPT Coding Control and Licensing Fees

Senator Bill Cassidy, chair of the Senate Health, Education, Labor, and Pensions Committee, has sent a letter to the American Medical Association (AMA) demanding transparency regarding its control and profit generation from the Current Procedural Terminology (CPT) coding system. The CPT system, owned by the AMA, is integral to provider reimbursement and billing, requiring hospitals and clinicians to license over 11,000 codes with annual royalties. The inquiry follows a recent CMS announcement of a 2.5% cut to physician payments, raising concerns about reimbursement calculations. The AMA has a CPT Editorial Panel overseeing code and relative value unit (RVU) assignments, including physicians, national medical groups, payers, and hospital representatives, with input from federal agencies like CMS and the CDC. Senator Cassidy's letter questions the inclusivity of physician input, especially as many doctors opt out of AMA membership, and requests detailed financial disclosures about CPT licensing fees, which reportedly generated $513.2 million last year. He also critiques the AMA's broader policy advocacy, including diversity, equity, and inclusion (DEI) mandates and gender-transition care policies, seeking clarity on funding, partnerships, and member opt-out options. The AMA maintains that licensing fees are reasonable and deny that fees increase healthcare costs. Cassidy has set a December 15 deadline for AMA's response and warns of additional measures to obtain information if necessary.