Secretary Kennedy is right to question the cost and power of the American Medical Association’s Current Procedural Terminology monopoly. But eliminating CPT would solve the wrong problem—and could create a much larger one.
CPT is deeply embedded in American healthcare. It is the common language used to describe conventional medical services, process claims, and move enormous volumes of information through the insurance system. Whatever one thinks of the AMA’s role in controlling it, CPT has become critical infrastructure. Replacing it outright would be expensive, disruptive, and unnecessary.
The better answer is competition.
HHS does not need to tear down the existing coding system. It can preserve CPT while recognizing a complementary code set that fills the gaps CPT does not—and was never designed to—cover. That single change would end the practical monopoly over reimbursable care, open the claims system to a broader licensed healthcare workforce, and allow policymakers to measure whether those additional choices actually reduce costs.
Keep CPT. Fill the gaps. Open access. Measure the results.
The Real Cost Problem
America spent approximately $5.3 trillion on healthcare in 2024, or $15,474 for every person in the country. That is the number reform should be organized around.
For decades, the dominant strategy for controlling healthcare spending has been to squeeze payment within the existing system: lower reimbursement, tighter networks, more utilization review, fewer covered services. Yet the underlying cost problem remains. At the same time, physicians and hospitals face increasing administrative pressure, workforce shortages, and shrinking capacity.
There is another way to think about cost. Sometimes more access to lower-cost care can mean less spending overall.
Consider a patient with hypertension, chronic pain, anxiety, or another condition that can worsen gradually before producing an expensive crisis. Earlier access to lower-cost services—whether behavioral care, acupuncture, nutrition support, physical therapy, massage therapy, or another legally authorized intervention—may help manage symptoms and risk before the patient reaches an emergency department, hospital bed, or more intensive treatment pathway.
The point is not to assume that every alternative service works for every patient. The point is to create a system capable of finding out.
Guardrails against overuse are appropriate. So is outcome measurement. But excluding care from reimbursement before it can generate claims data creates a circular problem: the system says there is not enough evidence because it does not collect the data, and it does not collect the data because the service is not coded and reimbursed.
America Already Has a Broader Healthcare Workforce
Millions of licensed healthcare professionals already provide care outside the physician model: advanced practice nurses, chiropractors, acupuncturists, naturopathic doctors where licensed, behavioral health professionals, midwives, nutrition professionals, massage therapists and bodyworkers, physical and occupational therapists, pharmacists, and others operating within state-defined scopes of practice.
These practitioners do not replace physicians. They give patients additional doors into the healthcare system and can allow physicians, emergency departments, and hospitals to concentrate on the patients who require higher levels of medical care.
But much of this work remains difficult or impossible to identify accurately in the conventional claims stream. Without an appropriate code, there is often no practical route to reimbursement. Without reimbursement, there is little or no claims data. Without claims data, lower-cost approaches remain largely invisible to the people deciding what insurance should cover.
That is the central policy failure.
Coding identifies the service. Reimbursement brings the service into the claims system. Claims data then makes comparison possible—against CPT-coded care, HCPCS Level II services, hospital utilization, prescriptions, total annual spending, and the cost of managing chronic conditions over time.
If policymakers want to know whether broader access actually lowers the $15,474 annual cost per person, the care has to be visible before it can be judged.
The Problem Is Not CPT. It Is Exclusivity.
CPT does an extraordinary job of describing conventional medical care. The mistake was allowing a code set controlled by a physician trade organization to become, in practice, the primary gatekeeper for reimbursement across a healthcare economy that includes many other licensed professions.
That is not an argument for destroying CPT. It is an argument for ending exclusivity.
HHS can establish or recognize a complementary coding framework for services that fall outside CPT’s practical reach. Those codes can be connected to state scope-of-practice rules so payers can determine whether a practitioner is legally authorized to provide the service in that state. That creates a rational boundary: not every service is automatically covered, but every legally provided service can at least be accurately identified, evaluated, and measured.
This approach would also give policymakers something they have never had in a complete form: a 360-degree view of the care Americans are already using.
Direct reimbursement to legally authorized practitioners can reduce unnecessary layers of physician oversight in settings where the law does not require them. More importantly, it creates the data needed to identify which services, practitioners, and care pathways improve outcomes, reduce escalation, and lower the total cost of chronic care.
That data can create a continuous improvement cycle. Services that demonstrate value can expand. Services that do not can be limited or removed. New approaches can enter the system and be judged by the same scoreboard rather than by whether they fit inside an incumbent coding structure.
Don’t Replace CPT. Expand What We Measure.
Reimbursement is not simply payment. It is the mechanism that makes healthcare visible to the system responsible for evaluating cost and outcomes.
Conventional CPT-coded medicine should remain the benchmark. But it should not be the only care that can enter the dataset. A complementary code set would allow lower-cost and non-physician care to compete on measurable results: total annual cost per patient, utilization of expensive services, chronic-care spending, functional outcomes, and other relevant measures.
Critics will reasonably ask whether broader reimbursement could encourage ineffective or unnecessary care. That is precisely why coding and measurement matter. The answer to uncertainty should not be permanent invisibility. It should be transparent data, clear scope-of-practice rules, appropriate guardrails, and evidence generated from real-world claims.
This is not about replacing doctors. It is about using the full healthcare workforce more intelligently and learning which forms of care can prevent patients from needing the most expensive resources in the system.
And it can be tested without dismantling the infrastructure we already depend on.
America already has the practitioners. It already has the electronic claims infrastructure. It already spends $15,474 per person each year.
What it lacks is the ability to see and compare all of its legal healthcare choices.
The fastest path to lower healthcare costs may not be less care. It may be earlier access to the right care, from the right practitioner, at the right time—and a coding system capable of proving what works.
More access. More choice. Less cost.
Source note: 2024 U.S. national health expenditure and per-capita figures are from the Centers for Medicare & Medicaid Services National Health Expenditure data.
