Senator Bill Cassidy, MD (R-LA), Chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, has been publicly scrutinizing the American Medical Association’s (AMA’s) control of the CPT coding manual.
All physicians rely on this manual for annual updates for procedure codes. While health plans can set their own coding and coverage policies, they typically rely on AMA’s CPT code definitions.
Sen. Cassidy criticizes the AMA’s “monopoly” over the CPT manual and the fees it charges physicians to use the codes. The AMA’s process for updating CPT codes through its Relative Value Unit (RVU) Update Committee (RUC) has long been criticized, notably by HHS Secretary Robert F. Kennedy Jr. CMS began to distance itself from the AMA CPT’s code values in the 2026 Medicare Physician Fee Schedule final rule.
Sen. Cassidy’s Request for Information (RFI) asks for specific data on the AMA’s licensing and royalty fees. The ACAAI Advocacy Council shared a letter with Sen. Cassidy that expresses our views on how AMA CPT can be improved.
The Advocacy Council suggested the following targeted reforms:
- Enhance transparency in processes: Make CPT Editorial Panel and RUC meetings fully public, including live webcasts and accessible archives, to foster accountability and broader stakeholder input without compromising proprietary discussions.
- Improve transparency in licensing and royalties: Require greater disclosure of fee structures, royalty models and contract terms to prevent opacity that burdens providers, payers, and health technology vendors. This could include standardized reporting on how royalties are applied across the health care ecosystem, such as in electronic health records, billing systems, and educational materials.
- Rebalance reimbursement priorities: Shift valuation methodologies to better recognize the time and expertise involved in cognitive, preventive, and chronic care management services, reducing the historical bias toward procedural and surgical interventions. This reform would support specialties like allergy/immunology, where ongoing patient management saves money and lives.
- Reduce administrative burdens and royalty stacking: Streamline licensing requirements and minimize cumulative royalty payments for single patient encounters, which can involve multiple touchpoints (e.g., providers, hospitals, payers). Simplifying these could lower overall system costs without eroding the AMA’s ability to maintain the codes.
Sen. Cassidy has yet to introduce legislation on this issue. However, the RFI suggests this is the ultimate goal of his effort. The Advocacy Council will remain engaged with Sen. Cassidy and other stakeholders to ensure that any changes do not adversely impact allergy practices.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
