K-STREET, 10,000 FEET: How the American Medical Association’s medical billing royalties could fund anti-Trump lawfare

THE LOWDOWN:

• The American Medical Association (AMA), the powerful trade group representing over 283,000 physicians nationwide, has leveraged hundreds of millions of dollars in royalty income generated from its government-mandated medical coding monopoly for left-leaning causes.

• The AMA’s CPT codes are embedded in nearly every health insurance billing system in the United States. Their use is mandated by the Centers for Medicare & Medicaid Services (CMS) and widely adopted across the private insurance market, requiring virtually all health systems, insurers, and providers to pay licensing fees.

• While the AMA describes the CPT system as essential infrastructure for efficient billing and clinical data exchange, its financial disclosures and public positions indicate that the organization has leveraged this funding for advocacy campaigns and legal briefs on a wide range of issues unrelated to clinical medicine.

• With more than $1.3 billion in assets, the AMA remains one of the most powerful and well-resourced policy players in the healthcare landscape.

The American Medical Association (AMA), the powerful trade group representing over 283,000 physicians nationwide, has leveraged hundreds of millions of dollars in royalty income generated from its government-mandated medical coding monopoly for left-leaning causes.

The AMA’s cache of cash has gone toward advocacy and litigation spanning climate change, COVID-era mandates, housing policy, immigration, and transgender issues, according to tax records and court filings reviewed by the Washington Reporter.

In 2023, the AMA earned over $284 million in royalties from the licensing of its proprietary Current Procedural Terminology (CPT) code set, making up a large share of its total $468 million in revenue.

The AMA’s CPT codes are embedded in nearly every health insurance billing system in the United States. Their use is mandated by the Centers for Medicare & Medicaid Services (CMS) and widely adopted across the private insurance market, requiring virtually all health systems, insurers, and providers to pay licensing fees.

This quasi-governmental authority over a foundational element of healthcare administration has created a lucrative and largely unregulated revenue stream.

While the AMA describes the CPT system as essential infrastructure for efficient billing and clinical data exchange, its financial disclosures and public positions indicate that the organization has leveraged this funding for advocacy campaigns and legal briefs on a wide range of issues unrelated to clinical medicine. These included many that are squarely at odds with the Trump administration.

In recent years, 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.

IRS filings show that the AMA spent over $1 million on legal fees in 2023 and has spent nearly $10 million on litigation expenses since 2016. This growing legal outlay has helped fund a wide-reaching litigation portfolio.

During the COVID-19 pandemic, the AMA filed amicus briefs supporting eviction moratoriums in cases such as Alabama Association of Realtors v. HHS and Skyworks v. CDC, arguing that evictions posed a public health threat. In cases including Roman Catholic Diocese of Brooklyn v. Cuomo and Danville Christian Academy v. Beshear, the AMA backed government restrictions on religious services and private schools, contending such closures were necessary to limit virus transmission.

Beyond pandemic-related litigation, the AMA has supported expansive interpretations of gender identity protections. In multiple cases, including U.S./L.W. v. Skrmetti and Brandt v. Rutledge, the AMA defended access to gender-affirming care for minors and opposed state-level restrictions on such treatment. The organization also filed legal briefs supporting public funding for sex reassignment surgery in veterans, endorsed students' rights to use restrooms and compete in sports according to gender identity, and defended school policies requiring teachers to use preferred pronouns.

The AMA’s litigation efforts have extended to immigration as well. In Department of Homeland Security v. Regents of the University of California, the AMA opposed the Trump administration’s rescission of DACA, citing its potential impact on medical students and underserved communities. In California v. McAleenan, it filed to block federal rules that would expand the detention of unaccompanied migrant children, citing mental and emotional health concerns.

These efforts haven’t gone unnoticed in the health care space.

“The AMA has the size and scope and reach to make a monumental difference, and we’ll always encourage it to put resources to work that impact patients where and how they live,” Terry Wilcox, the Chief Mission Officer of Patients Rising, told the Reporter.

“Health care is being shaken up in Washington — that is something we should all be prioritizing as never before,” Wilcox said.

With more than $1.3 billion in assets, the AMA remains one of the most powerful and well-resourced policy players in the healthcare landscape.

But as its role expands into highly politicized legal territory, calls are growing in Congress and among industry stakeholders for greater transparency and potential reform — starting with a closer examination of how CPT royalties are collected, governed, and spent.

The AMA did not respond to request for comment.