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Certified Professional Coder (CPC®)

A Certified Professional Coder has proven by rigorous examination and experience that they know how to code, rationales for why particular codes are used and can do so both efficiently and effectively. A CPC® can review and adjudicate coding of services, procedures and diagnoses on medical claims in the physician-office setting, thus improving the finances and operational efficiency of the practice. 

The CPC®'s abilities include:

  • Proficiency in adjudicating claims for accurate medical coding for diagnoses, procedures and services in physician-based settings
  • Proficiency across a wide range of services, which include evaluation and management, anesthesia, surgical services, radiology, pathology and medicine
  • Sound knowledge of medical coding rules and regulations including compliance and reimbursement. A trained medical coding professional can better handle issues such as medical necessity, claims denials, bundling issues and charge capture
  • Knowing how to integrate medical coding and reimbursement rule changes into a practice's reimbursement processes
  • Knowledge of anatomy, physiology and medical terminology necessary to correctly code provider diagnosis and services

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The CPC® Exam

  • 150 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • 1 free retake

The CPC® examination consists of questions regarding the correct application of CPT®, HCPCS Level II procedure and supply codes and ICD-9-CM diagnosis codes used for billing professional medical services to insurance companies. It is designed to evaluate a physician practice coder’s knowledge of the following:

  • Anesthesia
  • Radiology
  • Medicine
  • Nervous
  • Endocrine
  • Digestive
  • Urinary
  • Musculoskeletal
  • Evaluation and Management
  • Anatomy and Physiology
  • Mediastinum & Diaphragm
  • Practice Management
  • Male/Female Genital
  • Hemic & Lymphatic
  • Maternity & Delivery
  • Eye & Ocular Adnexa
  • ICD-9-CM
  • HCPCS Level II
  • Coding Guidelines
  • Medical Terminology
  • Pathology
  • Integumentary
  • Respiratory
  • Laboratory

Medical Coding Certification Requirements

  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.
    1. New members must submit membership payment with examination application.
    2. Renewing members must have a current membership at the time of submission and when exam results are released.
  4. Effective January 2010 all exams will be reported with exact scores and will report the top three areas of weakness

A CPC® must have at least two years medical coding experience (member's 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.

Note:
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 page.

Due to the level of expertise required of medical coders, the 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 before receiving the full credential. 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 certificate.

CPC-A®, CPC-H-A®, or CPC-P-A® Status: Member's with an Apprentice designation are required to submit the annual CEU's while completing the coding work experience requirement.

Requirements for Removal of Apprentice Designation: Two letters of recommendation verifying 2 years of on the job experience using the CPT®, ICD-9-CM, or HCPCS code sets. One letter must be on letterhead from your employer. Both letters are required to be typed and signed and will need to outline your coding experience and amount of time in that capacity.

OR

A minimum 80 hours of coding education AND one letter on letterhead from your employer verifying one year of on the job experience using the CPT, ICD-9-CM or HCPCS code sets. Proof of education may be sent in the form of a letter from an instructor on school letterhead stating the amount of contact hours earned, a certificate/diploma stating at least 80 contact hours or a school transcript.

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