Cassidy Demands More Answers From AMA on Its Billing Code Business

 Sen. Bill Cassidy, MD (R-La.), lashed out at the American Medical Association (AMA) on Monday, saying that the organization's response to his previous letter demanding details about its Current Procedural Terminology (CPT) code business was nowhere near good enough.

Although openness and transparency are essential tenets of providing care to patients and families, "the AMA's October 23 reply to my October 6 letter was anything but open and transparent," Cassidy, chairman of the Senate Health, Education, Labor, & Pensions (HELP) Committee, wrote in a letter to AMA President Bobby Mukkamala, MD. "I am concerned that the status quo focuses on enriching the AMA at the expense of patients, while the organization subsequently uses the revenue to advance a political agenda that is not representative of the majority of the medical community. Your recent response did not answer my questions [in a way] that could assuage this concern."

The AMA maintains and annually updates the CPT coding system, which is used by physicians and other healthcare professionals to document and bill for services throughout the healthcare system. In his letter, Cassidy went on to ask some very detailed questions about the AMA's CPT code operation.

He noted that the AMA generated a total revenue of $513.2 million last year, with $281.4 million of that amount generated from "books and digital content."

"However, AMA does not provide transparency about how many millions in revenue it receives from licensing CPT products, subscriptions, and other educational materials," he wrote, going on to ask a litany of questions about the total revenue amount generated specifically from the sale and licensing of CPT coding materials, the administrative costs associated with generating CPT coding materials, the AMA's calculation of the for-sale price of CPT coding materials and how that price has changed in the last 5 years, and the revenue that the AMA has generated from the sale of CPT coding materials and related products and subscriptions in the last 5 years.

Cassidy also noted that, as part of the AMA's editorial process, it gives interested parties (IPs) who may be affected by panel decisions the ability to comment on code change applications (CCAs) to create or modify a CPT code.

"Does the AMA require that IPs have a membership with the AMA to participate in this process?" he asked. "How much weight does the AMA give to IPs comments when determining their CCAs? Yearly, how many CCAs are accepted? Further, what is the average amount of requests that end in coding modifications or changes?"

In addition, Cassidy pointed out that, as part of the AMA's CPT Distribution Pricing Schedule for 2025, it charged $18.50 for each user, as well as an upfront annual royalty fee of $1,050.

"The AMA also charges for an assortment of other products, such as an additional $18.50 to access the Relative Value Units (RVUs) associated with individual CPT codes," he wrote, asking for the number of users who accessed the AMA's licensing models in 2024 and the organization's definition of "users."

He also asked whether fees were calculated based on each unique user or on a per-code basis for providers, health plans, hospitals, and electronic health record software companies who access CPT codes.

Cassidy also pointed to issues not related to the CPT codes, including policies supporting diversity, equity, and inclusion (DEI) mandates and gender-affirming care.

"What partnerships and associations, both financial and non-financial, does the AMA have with organizations or projects supporting DEI mandates and gender-transition procedures?" he asked. "How have previous resolutions passed by the House of Delegates informed the AMA's advocacy and support on behalf of DEI mandates and gender-transition procedures? Do membership fees directly or indirectly fund activities of the House of Delegates? How does the AMA calculate advocacy when it assesses membership fees? Does the AMA give members the ability to opt out of supporting advocacy activities?"

In his earlier letter, Cassidy said he was "particularly offended by the AMA abusing its government-endorsed CPT monopoly to charge every stakeholder in the healthcare system significant amounts of money while advancing an anti-patient agenda." He argued that the AMA is "charging exorbitant fees to anyone using the CPT code set, including doctors, hospitals, health plans, and health IT vendors," and that such fees are "passed on by CPT users to patients in the form of higher healthcare costs."

In his new letter, Cassidy gave the AMA a Dec. 15 deadline for a response, adding, "If you are unable to voluntarily reply in a fulsome and timely manner, the committee will consider other options to secure the information requested from the AMA."

The AMA has received the letter and is responding to it, MedPage Today has learned. The association offered no further comment.

https://www.medpagetoday.com/practicemanagement/reimbursement/118799