## Facts

- The American Medical Association (AMA) created and copyrighted the Physician’s Current Procedural Terminology (CPT), a coding system assigning five-digit codes and brief descriptions to thousands of medical procedures.
- Congress directed the federal agency administering Medicare and Medicaid to establish a uniform physician-services code for claim forms.
- The agency contracted with the AMA to adopt CPT and received a nonexclusive, royalty-free, irrevocable license to use, copy, publish, and distribute CPT.
- The agency agreed not to use any other procedure-nomenclature system for reporting physicians’ services and to require CPT use in its administered programs whenever possible, though it retained a contractual right to terminate on notice.
- The agency incorporated CPT into a federal coding framework and adopted reimbursement-related requirements that depended on CPT codes; other public bodies also incorporated or required CPT use.
- Practice Management Information Corporation bought CPT books from the AMA for resale; after a discount dispute, it planned a publication that would include CPT code numbers.
- Practice Management sued for declaratory relief, contending (1) CPT became uncopyrightable “law” once mandated in public programs and (2) the AMA’s federal licensing arrangement constituted copyright misuse.
- The district court granted partial summary judgment to the AMA and issued a preliminary injunction barring Practice Management from publishing CPT.

## Issues

1. Whether CPT’s incorporation into, and mandatory use within, public reimbursement and regulatory schemes made CPT uncopyrightable as “law.”
2. Whether the AMA’s licensing agreement that restricted the federal agency from using competing coding systems constituted copyright misuse barring enforcement.
3. What effect a finding of copyright misuse has on the availability of injunctive relief and other enforcement against an alleged infringer.

## Decision

- The Ninth Circuit held CPT did not lose copyright protection merely because public programs required its use.
- The Ninth Circuit held the AMA committed copyright misuse by leveraging CPT’s copyright through a licensing arrangement that suppressed competing coding systems.
- The court reversed the partial summary judgment, vacated the preliminary injunction, and remanded for further proceedings.
- The court stated misuse does not invalidate the copyright, but prevents enforcement during the period of misuse.

## Legal Principles

- A privately authored work does not become uncopyrightable “law” solely because government regulations incorporate it by reference or require its use for compliance.
- Copyright misuse is an equitable defense that bars enforcement when a copyright holder exploits the copyright contrary to public policy reflected in copyright law.
- Using a copyright license to obtain market control beyond copyright’s scope—such as constraining adoption of competing systems—can constitute misuse.
- Upon a successful misuse defense, the copyright remains valid, but enforcement remedies (including injunctions) are unavailable until the misuse is purged.

## Conclusion

The Ninth Circuit concluded that CPT remained copyrightable despite regulatory reliance, but the AMA’s agreement restricting the government’s use of competing coding systems was copyright misuse, requiring reversal of enforcement-related rulings and vacatur of the injunction against publication.


Practice Mgmt. Info. Corp. v. Am. Med. Ass'n, 121 F.3d 516 (9th Cir. 1997)