The codes that translate medical care into billable work are woven into the machinery of American healthcare. A new lawsuit is asking an unexpectedly fundamental question: Should anyone own them?
There is a peculiar moment in nearly every medical encounter when medicine stops being medicine and becomes something else. A physician has listened to a patient, examined a body, considered a differential diagnosis, perhaps removed a lesion, repaired a wound, interpreted a tracing, performed a procedure, or spent forty minutes trying to make sense of a collection of symptoms that refused to arrange themselves neatly into a textbook diagnosis. Then the encounter must be translated. The complexity of what happened in the room is compressed into a series of numbers. Five digits here. A modifier there. The numbers travel onward, through electronic health records and billing systems and clearinghouses, until eventually they reach an insurer and help determine what the work was called and what someone might pay for it.
Physicians know these numbers as CPT codes, part of Current Procedural Terminology, a system so deeply embedded in American healthcare that it can feel less like a product than a law of nature. There are more than 11,000 of them, covering medical services and procedures from ordinary office visits to increasingly complex interventions. Medicare uses them. Medicaid uses them. Private insurers use them. Medical practices use them. Technology companies build around them. They are part of the plumbing beneath an enormous healthcare economy, mostly invisible until something goes wrong with a claim and someone, somewhere, discovers that the difference between payment and denial may reside in a few digits.
And those digits belong to someone.
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The American Medical Association created and maintains CPT and holds the copyright to the code set. The AMA describes CPT as the “language of medicine,” an apt phrase considering how thoroughly the system has become the common vocabulary through which medical work is communicated for billing and administrative purposes. The organization updates that vocabulary as medicine changes, with an editorial process that considers new, revised, and deleted codes. A world of new procedures, technologies and services cannot run indefinitely on an old dictionary. Someone has to keep rewriting it.
The unusual part is what happened after the dictionary became indispensable.
As Medscape Medical News recently reported, PatientRightsAdvocate.org, a nonprofit organization focused on healthcare price transparency, filed a lawsuit in August seeking to invalidate or render unenforceable the AMA’s copyrights over CPT and to publish the complete code set online for free. The organization says it purchased the 2026 CPT codebook and wants to turn it into a searchable resource available to the public. For now, it is waiting for a federal court to tell it whether doing so would violate the AMA’s copyright.
At first glance, this sounds like an intellectual-property dispute, the sort of disagreement best left to lawyers who enjoy phrases like “copyright misuse” and “declaratory judgment.” Look at it for another moment, though, and the case begins to raise a much larger question about the architecture of American healthcare. If physicians and healthcare organizations are effectively required to communicate through a particular coding system in order to participate in much of the healthcare economy, what does it mean for that language to remain privately owned?
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That question becomes especially interesting because CPT is simultaneously accessible and restricted. CPT information can be found through the Centers for Medicare & Medicaid Services, but CMS itself displays an AMA licensing agreement governing use of the material. The agreement identifies the AMA as the copyright holder and restricts unauthorized copying, distribution, modification and commercial use. The AMA, meanwhile, explains on its own licensing pages that organizations using, referencing or displaying CPT content generally need appropriate authorization or licensing, depending on the use. Buying a CPT book does not give its owner the right to turn the contents into an electronic product or freely distribute them.
In other industries, none of this would be especially remarkable. People create intellectual property. Organizations invest money in maintaining it. Users pay to license it. Copyright exists precisely because useful things require labor to create.
Healthcare complicates the arrangement because CPT is not simply a reference book sitting on a shelf waiting for interested readers. It has become infrastructure.
CMS says American health insurers process more than five billion claims for payment each year and describes standardized coding systems as essential to processing those claims consistently. CPT makes up Level I of the federal Healthcare Common Procedure Coding System. The lawsuit goes further, arguing that federal requirements and the laws of at least 45 states have incorporated CPT into government healthcare programs and billing requirements. The plaintiffs therefore contend that a private copyright should not restrict public access to a standard that government itself has made integral to the operation of healthcare.
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Their argument amounts to a provocative thought experiment. Imagine that the government required millions of people to conduct essential business using a particular dictionary. Imagine that enormous sums of money could change hands depending on which words from that dictionary were selected. Then imagine discovering that the dictionary remained private intellectual property and that certain uses required licensing.
At what point does a product become public infrastructure?
There is money at stake, although precisely how much remains an important point of uncertainty. Medscape reported that the lawsuit points to $296.4 million in AMA revenue from “books and digital content” in 2025. PatientRightsAdvocate.org alleges that CPT licenses and sales represent the overwhelming share of that category. The AMA does not publicly break out CPT-specific revenue, according to Medscape, so the plaintiff’s claim should not be confused with a disclosed CPT revenue figure. That distinction matters. It also illustrates why the lawsuit has attracted attention beyond a narrow copyright dispute: CPT sits at the intersection of medicine, regulation and an enormous healthcare payment system, yet many of the economics surrounding the coding system remain largely invisible to the physicians who use it every day.
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The challenge is not occurring in isolation. Medscape also noted that CMS, in its proposed 2027 Physician Fee Schedule, has sought public comment about potential alternatives to CPT and about challenges associated with the AMA’s control over CPT licensing. Senator Bill Cassidy, a physician and chair of the Senate Health, Education, Labor and Pensions Committee, has separately questioned the AMA about its control of the coding system and the revenue associated with it. A structure that spent decades largely functioning as background machinery is suddenly being examined in the foreground.
There is, however, an inconvenient question for anyone attracted to the simplicity of making the codes free: Who maintains the language afterward?
Medicine does not stand still. New procedures emerge. Old ones disappear. Technology changes what physicians can do. Entire categories of care evolve. The AMA’s CPT Editorial Panel meets multiple times each year to consider changes to the code set. Maintaining a standardized vocabulary used across a healthcare system this large requires expertise, administration and infrastructure. Those things cost money. Eliminating licensing revenue does not eliminate the work.
The AMA has said it intends to vigorously defend its intellectual-property rights, arguing that CPT is continuously updated through a process that brings together medicine, government and industry. That defense deserves consideration because the alternative to privately funded infrastructure is not infrastructure without cost. It is infrastructure funded differently. Government could potentially support the work. CMS could assume a larger role. Another organization could administer the system. A new coding framework could eventually replace it. Each possibility would bring its own bureaucracy, expense and opportunities for dysfunction.
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The deeper issue, then, may be how American healthcare arrived at an arrangement in which the vocabulary required to describe medical work functions simultaneously as a private asset and a quasi-public utility.
Physicians occupy a particularly strange position inside that arrangement. They generate the care being described. They document it. They select or approve the codes representing it. Their reimbursement can depend upon those codes. Yet most physicians have remarkably little influence over the larger machinery through which their work is converted into economic value. The physician performs the service, another system defines the language used to describe it, government and insurers establish payment rules around it, software companies operationalize it, and an administrative ecosystem grows around making sure everyone has translated the original act of medical care correctly.
It is difficult to think of a better metaphor for modern medicine.
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A conversation between a doctor and a frightened patient can contain uncertainty, judgment, reassurance, risk, experience and years of accumulated clinical instinct. None of those things travels particularly well through a claims processor. The healthcare system therefore needs abstraction. It needs categories. It needs codes. Five billion claims cannot be adjudicated as five billion individual stories.
Still, every abstraction eventually acquires power. Once a language determines how work is recognized, measured and paid for, control over that language matters.
Perhaps PatientRightsAdvocate.org will prevail. Perhaps the AMA will successfully defend the copyright. Perhaps the litigation will ultimately change far less than its proponents hope. Courts will decide the legal questions, and the legal questions are narrower than the philosophical ones the case exposes.
For physicians, the more interesting development may be that something long treated as an immutable feature of practicing medicine is suddenly being questioned at all.
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CPT codes have become so ordinary that a generation of physicians has learned them alongside the other administrative rituals of modern practice. Pick the code. Add the modifier. Submit the claim. Fix the denial. Repeat. The process becomes habit, and habit has a way of disguising design choices as inevitabilities.
The lawsuit reported by Medscape pulls one of those choices back into view. Behind the five-digit numbers is a privately maintained language. Behind that language is an organization. Behind the organization is an economic model. And surrounding all of it is a healthcare system that has come to depend on the vocabulary so completely that imagining medicine without it feels almost impossible.
That may ultimately be the most interesting question raised by the case. American medicine unquestionably needs a common language for describing the work physicians do. Maintaining that language unquestionably requires resources.
The question now being asked is who gets to own the dictionary.
Once a language determines how work is recognized, measured and paid for, control over that language matters.
