Kennedy Seeks AMA Code Cost Data

Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. has asked Americans to comment on the future of medical coding and billing, specifically regarding the cost of Current Procedural Terminology (CPT) codes used by the health care system. The American Medical Association (AMA) charges organizations to use these codes, with costs totaling over $300 million last year.

Practices have until September 14 to respond to the request for comment, which is part of the CY 2027 Medicare Physician Fee Schedule proposed rule. As of August 31, the docket had received over 19,000 comments.

The AMA says that licensing revenue from CPT codes funds the development and maintenance of the code set, which underpins interoperability across the health system. Without a shared language, health information stops moving cleanly and patient access suffers.

In a video posted on the official HHS YouTube channel, Kennedy directed viewers to the Federal Register to comment on the future of medical coding and billing. The video was also shared on the MAHA Action account on X, formerly Twitter.

Section II.H of the proposed rule asks commenters to identify harms or challenges tied to AMA licensing of CPT-4, including licensure cost and delayed innovation. It also asks whether private competition could supplement the standard and what alternatives exist to the AMA/Specialty Society Relative Value Scale Update Committee.

The CMS cited “longstanding concern expressed over the Federal reliance on a private organization with such an obvious conflict of interest.” However, the agency has proposed nothing in this regard, and the request for comment carries no timeline and no requirement that the agency act.

In the same rule, the CMS proposes accepting close to 100% of the AMA’s direct practice expense recommendations for 2027.

CPT license fees run $18.50 per year for each user, according to AMA CEO John Whyte, M.D.. Health plans pay 24 cents per member per year, while providers also pay an annual access fee of $82.50. A physical copy of the code set costs $137.89.

Practice managers should look at the per-user structure of the fees, as royalties are set as an annual per-clinician or per-user charge regardless of claim volume. This means that a part-time clinician, a supervising physician who rarely bills, and a staff member with system access can each carry a fee.

SimplePractice, an electronic health record company, passes through $20 per clinician per year and bills every paid clinician on the account. A practice running an EHR, a clearinghouse, a coding reference tool, and an outsourced billing vendor may be paying CPT royalties inside four separate contracts without a line item that names them.

A transition away from CPT codes would require significant changes, including charge master and fee schedule updates, EHR and practice management remapping, superbill revisions, coder and front-desk retraining, and denial risk while payers and staff catch up.

The 2027 rule already contains four small versions of such a transition, including bundling 17 remote physiologic and remote therapeutic monitoring CPT codes into four new HCPCS G-codes. A broader move away from CPT would multiply these changes across every service line and reach payer contracts that reference CPT by code.

The proposed rule also includes other changes, such as converting the G2211 complexity add-on into a modifier that raises the underlying office or outpatient evaluation and management payment by 16%. It also proposes reducing payment for the lesser service when a procedure and a separate E/M visit are billed together.

The MGMA published a member analysis of the proposed rule on July 22. The litigation alongside the proposed rule includes a lawsuit filed by PatientRightsAdvocate.org against the AMA in Illinois federal court, seeking to invalidate the CPT copyrights so that the 2026 code set can be published in searchable form for free.

An AMA spokesman told journalists that the association will vigorously defend its intellectual property rights, describing CPT as medicine’s uniform language maintained through an open process. The CPT Editorial Panel costs the government nothing, and its meetings are open to any stakeholder.

Comments on the proposed rule can be submitted to regulations.gov under docket CMS-1848-P, by September 14.