Certified Professional Coder-Payer (CPC-P®)
More private and public payers (health plans) are recognizing the value of employing certified coders to process and analyze medical claims for payment. The CPC-P® credential meets the growing demand for certified coders in a payer environment.
The CPC-P® demonstrates a coder’s aptitude, proficiency and knowledge of coding guidelines and reimbursement methodologies for all types of services from the payer's perspective. Contributing developers include Dr. Marc Lieb, M.D., J.D., Susan Goldsmith, CPC, as well as a number of other well-known CPC-Ps in the payer community. Claims reviewers, utilization management, auditors, benefits administrators, billing service, provider relations, contracting and customer service staff can each benefit their practice with the CPC-P® credential.
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The CPC-P® Exam
- 150 multiple choice questions (proctored)
- 5 hours and 40 minutes to finish the exam
- 1 free retake
- Open code book (manuals)
The CPC-P® certification exam certifies that the successful candidate has the knowledge and skills to adjudicate provider claims effectively. The exam will test the examinee’s basic knowledge of coding-related payer functions with emphasis on how those functions differ from provider coding. The relationship between coding and payment functions will be explored in depth.
The CPC-P® exam consists of two parts, testing coding accuracy and reimbursement methodologies. The Medical Coding Concepts section will test the examinee’s understanding of medical terminology, anatomy and CPT®, HCPCS Level II and ICD-9-CM coding concepts. The Reimbursement Methodologies section will cover physician reimbursement, inpatient payment systems, outpatient payment systems, health insurance concepts and HIPAA.
Approved Manuals for Use During Examination
- CPT® Books (AMA standard or professional edition ONLY). No other publisher is allowed
- Your choice of HCPCS Level II
- Your choice of ICD-9-CM
Electronic devices with an on/off switch (cell phones, smart phones, tablets, etc.) are not allowed into the examination room. Failure to comply with this policy may result in disqualification of your exam.
Any officially published errata for these manuals may also be used. No other manuals are allowed. Each code set is updated annually; it is essential that examinees use the current calendar year's coding manuals when taking the certification exam. Questions on the CPC®, CPC-P® and CPC-H® tests do not require the use of any other outside material.
Individuals with a solid understanding of coding fundamentals, anatomy and terminology should be able to answer each examination question through application of the CPT®, ICD-9-CM or HCPCS Level II manuals or through careful reasoning.
Approved Exam Manuals
Non-Approved Manuals for Use During Examination
Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:
- Current Procedural Coding Expert® - Ingenix
- Procedural Coding Professional - Contexo
- Procedural Coding Professional - AAPC
- Procedural Coding Expert - Contexo
- Procedural Coding Expert - AAPC
- CPT® Insider's View - AMA
- CPT® Plus! - PMIC
- Coders' Choice CPT® - PMIC
- ICD-9-CM Easy Coder - Unicor
Medical Coding Certification Requirements
- We recommend having an associate's degree.
- Pay examination fee at the time of application submission.
- Maintain current membership with the AAPC.
- New members must submit membership payment with examination application.
- Renewing members must have a current membership at the time of submission and when exam results are released.
- Effective January 2010 all exams will be reported with exact scores. The CPC-P® exam will report the top three areas of weakness.
A CPC-P® must have at least two years medical coding experience (members with an apprentice designation are not required to have two years medical coding experience.) Membership is required to be renewed annually and 36 Continuing Education Units (CEU's) must be submitted every two years for verification and authentication of expertise.
Each examination is separate and distinct from one another. To obtain all certifications, each examination must be taken separately and passed. Continuing Education Unit (CEU) submissions are required for all certifications. For CEU requirements please see our CEU Information
Due to the level of expertise required of medical coders, AAPC expects certified coders to be
able to perform not only in an exam setting but also in the real world. In addition to passing the
certification exam, coders will also be required to demonstrate on-the-job coding experience.
Those who pass the CPC®, CPC-H® and/or CPC-P® exams but have not yet
met this requirement will be designated as an Apprentice (CPC-A®, CPC-H-A® and/or CPC-P-A®) on their
CPC-A®, CPC-H-A®, or CPC-P-A® Status: Members with
an Apprentice designation are required to submit annual CEUs while completing
the coding job requirement.
Requirements for Removal of Apprentice Designation:
To remove your apprentice designation via on-the-job experience, you must obtain and submit
two letters of recommendation verifying at least two years of on-the-job experience (externships
accepted) using the CPT®, ICD-9-CM, or HCPCS Level II code sets. One letter must be on letterhead
from your employer*, the other may be from a co-worker. Both letters are required to be signed
and will need to outline your coding experience and amount of time in that capacity. Download
our Apprentice Removal Template for
easier submission. Letterhead and signatures are still required when using this template.
Submit proof showing completion of at least 80 contact hours of coding education
AND one letter, on letterhead, signed from your employer verifying one year of on-the-job
experience (externships accepted) using the CPT, ICD-9-CM, or HCPCS Level II code sets.
Send proof of education in the form of a letter from an instructor on school letterhead stating
the 80 contact hour course has been completed, a certificate/diploma stating at least 80 contact
hours, or a school transcript.
Once ALL apprentice removal requirements have been met, you may submit them via fax, mail,
or scanned email. Please allow 2-4 weeks for processing.
*Employers can only verify time spent coding with their organization.
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