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Certified Professional Coder-Payer (CPC-P®)

A Certified Professional Coder-Payer (CPC-P®) is an individual of high professional integrity who has passed a coding certification examination sponsored by the American Academy of Professional Coders (AAPC). The CPC-P® demonstrates the payer 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., as well as a number of well-known CPC-P®'s in the payer community. The intended audience includes claims reviewers, utilization management staff, auditors, coordination of benefits staff, billing service, provider relations and contracting and customer service staff.

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  • Apprentice Status
  • Certification Requirements
  • Approved Manuals
  • CPC-P® Exam

CPC®, CPC-H®, or CPC-P® Apprentice: Examinees who are successful in passing the certification examination but have not yet met the required coding work experience will be awarded the initial designation CPC® Apprentice, CPC-H® Apprentice, or CPC-P® Apprentice. The CPC®, CPC-H®, or CPC-P® Apprentice is required to submit the annual CEUs while completing the coding work experience requirement. The apprentice will receive a certificate from AAPC for CPC®, CPC-H®, or CPC-P® Apprentice.

Requirements for removal of Apprentice designation for the CPC®, CPC-H®, CPC-P®: At least two recommendation letters verifying 2 years of on the job experience using the CPT®, ICD-9-CM, or HCPCS Level II code sets. At least one letter must be from a supervisor outlining your coding experience and amount of time in that capacity.

OR

A minimum 80 hour coding course AND one letter verifying one year of on the job coding experience from a supervisor. Proof of education may be sent in the form of a letter from the instructor stating the amount of contact hours or a certificate of completion stating the amount of contact hours.

Medical Coding Certification Requirements
In order to earn CPC®, CPC-H®, CPC-P® or CIRCC™ credentials:

  1. We recommend having an associate’s degree.
  2. Pay examination fee at the time of application submission.
  3. Maintain current membership with the AAPC.
    a. New members must submit membership payment with examination application.
    b. Renewing members must be current at the time of application submission as well as when results are sent.
    c. See “Fees for Membership and Examination” section for details.
  4. Starting in January 2009 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 and maintain yearly renewal as well as submit 36 Continuing Education Units (CEUs) every two years for verification and authentication of expertise.

Note:
Each examination is separate and distinct from one another. To obtain all certifications, each examination must be taken separately and passed. Continuing Education Units (CEUs) submissions are required for all certifications. For CEU requirements please see our CEU Policy page.

Approved Manuals for Use During Examination

In addition, any officially published errata update sheets for these manuals may be used. No other manuals are allowed. Examinees may use current calendar year and/or previous year code books. However, it is strongly suggested that only current manuals be used. Questions on the CPC®, CPC-P® or 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.

List of Approved 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

The CPC-P® Exam

  • 150 multiple choice questions (proctored)
  • 5 1/2 hours
  • 1 free retake
  • $300 ($260 AAPC Students)
  • Open Code book (manuals)

The CPC-P® certification exam certifies that the successful candidate has 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. Contributing developers include Dr. Marc Lieb, M.D., J.D., as well as a number of well-known CPC-P®'s in the payer community.

The CPC-P® exam consists of two parts with a total of 150 questions, 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.
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