By: Christopher Parrella, Esq., CPC, CHC, CPCO

Parrella Health Law, Boston, MA

A Health Care Provider Defense and Compliance Firm

A new federal lawsuit could have significant consequences for physicians, hospitals, billing companies and virtually every provider that submits claims in the United States. PatientRightsAdvocate.org has sued the American Medical Association seeking permission to publish the entire Current Procedural Terminology code set online for free. The case raises a provocative question: can a private organization claim copyright protection over a coding system that federal and state governments require providers to use?

CPT is the language of American medical billing. The five-digit codes identify medical procedures and professional services. According to the complaint, federal law requires CPT in virtually every electronic health care transaction, while federal law and at least 45 states require its use for Medicare, Medicaid and other government reimbursement. Medicare incorporates CPT classifications directly into its payment methodology, which then influences private payer reimbursement.

alleges that public access remains restricted because the AMA claims copyright ownership and licenses use of the code set. The organization says it purchased the 2026 printed CPT edition and wants to scan the entire publication, then make it freely available online. Rather than risk a copyright infringement action, it is asking a federal court for a declaratory judgment first.

The lawsuit advances three principal theories. First, it argues that CPT cannot be copyrighted because it has effectively become part of federal and state law. Second, it contends that even if the copyright remains valid, nonprofit publication of the codes would constitute fair use. Third, it alleges that the AMA has engaged in copyright misuse through its historic licensing relationship with the federal government.

The case does not start on a blank slate. The complaint points to a 1997 Ninth Circuit decision that found the AMA’s CPT copyright unenforceable at that time because of copyright misuse arising from its arrangement with the federal government. It also relies heavily on more recent cases involving privately developed technical standards incorporated into law. PatientRightsAdvocate.org argues those decisions support public access to CPT once government regulations make the codes mandatory.

The AMA disputes that position and has indicated it intends to vigorously defend its intellectual property. Its broader argument is that maintaining CPT requires substantial clinical expertise, continuous updating and coordination throughout medicine. The legal question will therefore involve not just transparency but whether mandatory governmental use of a privately developed standard eliminates or limits the developer’s copyright rights.

However, if you have questions about coding compliance, payer audits or billing risk, please contact Parrella Health Law at 857.328.0382 or Chris directly at cparrella@parrellahealthlaw.com.