What is the name of your organization?
If your commercial services or software solutions are provided to external clients, this is considered Distribution and will require a Distribution License Agreement. Please complete a Distribution License Request Form.
Please list the name of your organization as it appears on your license agreement so that we can ensure we are reviewing the correct account.
Please enter your AMA Contract ID so that we can ensure that we are reviewing the correct account.
Who should be contacted for follow ups?
Please provide the name of the institution, company, or other entity applying for content license
This must be a US address
This must be a US city
To ensure the best service for Distribution licensees, please be sure to explain your issue in detail in the comments section.
To ensure the best service for Internal Use licensees, please be sure to explain your issue in detail in the comments section.
Does anyone outside of your organization have access to AMA Data File? Do you provide services or solutions to customers/clients outside of your organization that require the use of AMA Codeset(s)? If so, this is considered distribution and you must complete a Distribution License Request Form.
How many users internal to your organization will be accessing the data file or the application that it is used within whether or not they see AMA codes directly. (For an explanation of "user", use CTRL+Click to open this link in a new https://compliance.ama-assn.org/hc/en-us/articles/360061118074 )
If you will be using the data within a third-party system, that vendor most likely requires a Distribution License with the AMA and you may have to license directly with them. If you do not see your software vendor listed, please select "Other" and name the software vendor in the text box.
Billing Provider - A health care provider who renders medical services for which a fee is charged.
How many users will be accessing the software or application, whether or not they directly see AMA Data File content? For assistance calculating user, please refer to this article https://compliance.ama-assn.org/hc/en-us/articles/360061118074-Internal-Use-License-Agreement-Request-26-or-More-Users
Please note the YEAR of the file that you are requesting.
By checking this box, you affirm that you will comply with the Clickwrap Agreement (press CTRL+click to access and review in a new page https://compliance.ama-assn.org/hc/en-us/articles/4404366953111 )
Please select the type of product, service or solution that you offer.
Redistribution of CPT material alone is not permitted; licensed products must include additional code-level content (i.e., content that appears when codes are displayed). For example, in an electronic medial record, the added content would be the patient encounter information such as date, patient name, and diagnosis.
An Upfront Annual Royalty Fee of $1,050 is due each calendar year during the Term of this Agreement. The Upfront Annual Royalty Fee is due prior to the execution of this Agreement by the AMA, and an additional Upfront Annual Royalty Fee is due no later than July 31 of each year thereafter during the Term of the Agreement.
In addition, AMA licenses CPT based on usage. Usage reports must be submitted to the AMA during the Term of the agreement to determine additional royalties.
A user is defined as an individual who: (a) accesses, uses, or manipulates CPT Editorial Content contained in the Electronic Licensed Product; or (b) accesses, uses, or manipulates the Electronic Licensed Product to produce or enable an output (data, reports, or the like) that could not have been created without the CPT embedded in the Electronic Licensed Product even though CPT Editorial Content may not be visible or directly accessible; or (c) makes use of an output of the Electronic Licensed Product that relies on or could not have been created without the CPT Editorial Content embedded in the Electronic Licensed Product even though CPT Editorial Content may not be visible or directly accessible.
The American Medical Association (AMA) agrees that the information provided by applicants will be kept confidential. I agree to keep the information provided by the AMA confidential. I confirm that all responses and related documentation submitted as part of the application process are accurate and complete to the best of my knowledge. I agree that I will notify the AMA if the information changes. Check to Agree
Check the box above to confirm that you are seeking to purchase the Data File.
You may select more than one
Tax exempt organizations will need to upload a certificate of exemption
Multiple files can be uploaded using the button at the bottom of this form
Please list the organization's primary address
including CITY, STATE, ZIP CODE
This is a required field. Please enter any additional comments or details that are necessary to complete this request.