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Medical Coding 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 examination certifies that the successful candidate has knowledge and skills to adjudicate provider claims effectively. The CPC-P® demonstrates the payer coder’s aptitude, proficiency, and knowledge within the payer environment. The intended audience includes claims reviewers, utilization management staff, coordination of benefits staff, provider relations and contracting and customer service staff.

A CPC-P® is an individual who in addition to on the job experience as a coder has achieved a measurable level of knowledge and expertise in coding of services, procedures and diagnoses for adjudication of medical claims.

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

The CPC–P®'s abilities include:

  • Demonstration of proficiency in assigning accurate codes for diagnoses, procedures and services performed by physicians and recognized licensed non-physician providers in physician-based settings.
  • Proficiency is required across a wide range of service areas, which include:
    • Evaluation and management
    • Anesthesia
    • Surgical services
    • Radiology
    • Pathology
    • Medicine
  • A sound knowledge of coding rules and regulations go hand in hand with keeping current on issues regarding medical compliance, and reimbursement. A trained coding professional can best handle issues such as medical necessity, claims denials, bundling issues and medically unlikely code sets.
  • A CPC-P® will be able to integrate coding and reimbursement rule changes into adjudication policies in a timely manner to include updating allowed amounts and EOB messages.
  • A CPC-P® has demonstrated knowledge of anatomy, physiology and medical terminology commensurate with ability to correctly code provider services and diagnosis.

The CPC-P® examination is designed to evaluate a
coder’s knowledge of:

Section 1: Clinical Knowledge
Medical Terminology (20), Anatomy (20)

Section 2: Reimbursement Concepts & Terminology
General Insurance (6), Payment Systems (5),
HIPAA (3), Payment Impacts (5), Inpatient (8)

Section 3: Applied Coding Concepts & Rules
ICD-9-CM Coding Rules (12), HCPCS (4), CPT®
Rules (13), CPT® Sections/Applied Coding (13),
Hospital Coding/Applied Coding (6), ICD-9-CM
Sections (21), HCPCS Level II (7), Modifiers (7)

A CPC-P® must have at least two years coding work experience that includes working with CPT®, ICD-9-CM, or HCPCS code sets and maintain yearly renewal as well as submit Continuing Education Units (CEUs) every two years.

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