Rep. Diana Harshbarger (R., Tenn.) wants top officials at the American Medical Association (AMA) to answer a series of her questions about changes the organization is looking at making to Current Procedural Terminology (CPT) codes that affect thousands of Americans. Harshbarger wants to ensure “CPT process that places the interests of patients and physicians ahead of competing commercial considerations,” she explained.
In a letter to Willie Underwood III and John J. Whyte, the AMA’s president and CEO, respectively, obtained exclusively by the Washington Reporter, Harshbarger wrote that she is concerned about changes to the CPT system that would “effectively determine competitive outcomes among manufacturers while potentially denying physicians appropriate reimbursement for services they legitimately perform on behalf of their patients.”
“In 2022, through the AMA’s own CPT Editorial Panel process, the Association approved updated descriptors for CPT codes 64555 and 64590,” the Tennessee lawmaker wrote to Underwood and Whyte. “Those descriptors were subsequently upheld on appeal, and for nearly three years physicians, patients, hospitals, ambulatory surgery centers, and both public and private payers have relied upon them in delivering and reimbursing peripheral nerve stimulation therapy.”
“During that time, thousands of Americans suffering from chronic pain have received meaningful relief through FDA-cleared peripheral nerve stimulation systems without reliance on opioids,” Harshbarger continued. “By manufacturers’ estimates, these systems have now been used in the treatment of more than 15,000 chronic pain patients. Coding standards upon which an entire field of medicine has relied should not be revisited absent compelling evidence that doing so is necessary and in the best interests of patients. Yet that appears to be precisely what the newly formed working group is considering. The AMA has cited ‘confusion’ as the basis for this review, yet Medicare and commercial payers have successfully applied these CPT codes since they became effective. To the extent concerns have been raised, they appear to stem largely from manufacturers of competing technologies that possess a direct commercial interest in the outcome of any reinterpretation of these codes.”
Harshbarger’s criticisms come at a critical juncture for the AMA; the Washington Post’s Dan Diamond and Christopher Rowland recently reported that the “Trump administration recently asked “for public suggestions on overhauling Medicare’s decades-old system for paying physicians, advancing officials’ long-running efforts to shift financial incentives toward primary care and prevention instead of costly procedures.”
In recent months, Republican lawmakers have upped scrutiny of the AMA, which has long been criticized by conservatives for a woke takeover. One former top AMA official recently said that the organization backs the Green New Deal and that “as physicians, we recognize climate change has negatively impacted… pregnant people.”
The Reporter previously published a lengthy investigation into how the AMA’s “medical billing royalties could fund anti-Trump lawfare,” finding that “the AMA has filed legal briefs not only in support of environmental regulations — such as defending the Biden administration’s EPA’s authority to regulate greenhouse gas emissions in West Virginia v. EPA — but also to support eviction moratoriums, school closures, the Deferred Action for Childhood Arrivals (DACA) program, and expanded transgender rights in education and healthcare.” The AMA also “spent over $1 million on legal fees in 2023 and has spent nearly $10 million on litigation expenses since 2016,” according to the Reporter’s analysis.
For Harshbarger, the potential AMA revisions are also problematic because of the “lack of transparency surrounding this process.” It is also one of her latest feuds with the organization, which is under fire from lawmakers like Harshbarger and from a bipartisan coalition for unrelated moves by it that Harshbarger said will increase the costs of childbirth. “The AMA now wants to make having a baby MORE expensive,” she wrote of other AMA billing revisions, which the Reporter covered.
“The AMA has declined to disclose the membership of the working group or the standards governing conflicts of interest and recusals,” she wrote. “Transparency is essential to maintaining the confidence of physicians, patients, Congress, and the public in the integrity and impartiality of the CPT process. Without knowing who is participating in this review — or whether participants have financial relationships with manufacturers whose commercial interests could be affected — it is impossible to determine whether the process is free from actual or perceived conflicts of interest. Decisions that may determine reimbursement for an entire category of patient care should be based on objective medical and coding principles, not on commercial interests, and they should be conducted in a manner that inspires public confidence.”
Harshbarger noted that she is writing to the AMA officials because she spent over three decades as a pharmacist, and because of what she works on as Vice Chair of the House Energy and Commerce Subcommittee on Health. Her litany of questions chiefly revolve around the AMA’s “October 23, 2025 announcement that it has established a working group to ‘evaluate and clarify’ the Current Procedural Terminology (CPT) coding structure for neurostimulator systems.”
“As a member of the congressional committee with primary jurisdiction over Medicare and much of the nation’s healthcare policy, I am concerned that this effort — framed as a remedy for alleged ‘confusion’ — could unsettle coding standards that have been in place for years and ultimately jeopardize Medicare beneficiaries’ access to a safe, effective, non-opioid treatment option for chronic pain,” she wrote.
“Having spent my career caring for patients in pain, I am especially concerned by any action that could reduce access to effective non-opioid therapies,” Harshbarger explained. “Our nation continues to confront the devastating consequences of the opioid epidemic, which has profoundly affected communities across East Tennessee and throughout the country. Policies that diminish access to proven, FDA-cleared alternatives risk pushing patients back toward opioid therapy or repeated surgical interventions. Rural Americans, who already face significant barriers to specialty care and often have the fewest available treatment options, would be disproportionately affected.”
In the wake of the AMA’s move, Harshbarger wrote to its top officials that she wants them to “publicly disclose the full membership of the neurostimulator coding working group, including each member’s professional and institutional affiliations.”
She also wants the AMA to “disclose the conflict-of-interest and recusal policies governing the working group, and identify whether any member or advisor has financial relationships — including consulting arrangements, research funding, equity interests, royalties, or other compensation — with manufacturers of neurostimulation devices. Individuals with such conflicts should be recused from deliberations affecting those interests” and to “identify the specific evidence demonstrating payer or physician ‘confusion’ that prompted formation of the working group, including any documented concerns from Medicare or commercial payers regarding implementation of CPT codes 64555 and 64590.”
Harshbarger additionally requested that the AMA both “commit to conducting any review through an open and transparent process that provides meaningful notice and an opportunity for physicians, patients, manufacturers, and other affected stakeholders to submit comments before any changes are finalized” and that it “provide assurance that any clarification or modification will be applied in a technology-neutral manner and will not be used to disadvantage any FDA-cleared device or deny physicians appropriate reimbursement for services they actually perform.”
Finally, she wants the AMA to “commit that no reinterpretation or modification affecting reimbursement will be implemented until the review process has been completed transparently and all interested stakeholders have had an adequate opportunity to provide input.”
