The Trump administration is examining the American Medical Association (AMA) over its control of medical billing codes, which some Republicans argue may stifle competition and increase healthcare costs nationwide.

Current Procedural Terminology (CPT) codes, developed by the AMA, are designed to provide a uniform system for coding medical procedures and services. However, concerns have been raised about the AMA’s dominant role in this system. The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule on July 16, 2026, requesting public comment on the influence of the CPT coding system and AMA’s process on physician payment policy. This initiative is part of the Secretarial priority to "Make America Healthy Again."

The proposed rule questions, "What, if any, evidence is there for CMS to consider regarding the harms or challenges associated with AMA’s monopoly over CPT-4 licenses for health care entities?" CMS highlighted longstanding concerns about federal reliance on a private organization with potential conflicts of interest, as the AMA provides information on the time and resources needed for physician services, which may affect payment rates.

CMS also noted that the historic dependence on CPT codes and the RVS Update Committee process might contribute to the U.S. healthcare system’s focus on treatment rather than prevention and lifestyle modifications, potentially hindering progress on health priorities.

Fred McGrath, executive director of the Institute for Legislative Analysis’ Center for Healthcare Affordability, described the AMA’s model as "a textbook case of regulatory capture," stating that the Health Insurance Portability and Accountability Act of 1996 effectively granted the AMA the authority to compel healthcare insurers, providers, suppliers, and government entities to use its codes.

In an October 2025 letter to the AMA, Senator Bill Cassidy expressed that he was "particularly offended" by the AMA’s alleged abuse of its government-endorsed CPT monopoly to charge significant fees to stakeholders while advancing what he called an "anti-patient agenda."

Some Republicans have voiced concerns about the AMA’s extensive influence over the medical care coding system, warning that it could limit competition and drive up healthcare costs.

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