I have negotiated with the AMA in several arenas. If they had anymore lawyers in a single place it would create a black hole.
Everything in healthcare anything (procedure, test, sponge, scalpel, etc) that gets billed or reported to the federal government, that is roughly ~2.7 Trillion worth of transactions a year, roughly 160 billion line items, requires a CPT code (current procedure terminology). The federal government legally requires this. CPT is owned and licensed by the AMA, they spend incredible lobbying dollars to maintain that the CPT codes are used and required by the federal government. It is legally impossible to create an alternative. It is complete regulatory capture. That CPT revenue was 160 million a year as of 2018. A pure tax on healthcare, sadly one among many. Also a reason truly fully open source systems are impossible in healthcare.