Game of Codes: The Ethics and Politics of Physician Payment and Coding

Abstract: Although Medicare physician fees are established through federal regulation, the relative values assigned to medical services are heavily influenced by a committee of specialty societies convened by the American Medical Association (AMA), which also owns the Current Procedural Terminology (CPT) billing codes. This session asks: What ethical concerns arise when a private professional organization both controls standards essential to the healthcare system and receives substantial revenue from their use?

Miriam Laugesen, Associate Professor of Health Policy and Management at Columbia University’s Mailman School of Public Health, will draw on her book Fixing Medical Prices to examine how conflicts of interest, limited transparency, and unequal representation in price-setting have contributed to the undervaluation of primary care. She will also explore how the AMA established CPT as essential national billing infrastructure, creating a “walled garden” of copyrighted codes, and consider the implications of CPT’s expansion into AI-powered health services. This Ethics Grand Rounds will discuss ways in which the AMA’s financial and organizational interests may be at odds with ethical, democratic governance. How can physician expertise and professional self-governance be preserved while ensuring transparency, accountability, and the fair valuation of medical care?