Taking the COC® exam

Take the COC Exam and become a Certified Outpatient Coder.

With more and more physicians choosing to join hospital groups over private practices, the need for certified outpatient coders continues to escalate, making COC certification a smart career move.

Outpatient coders report procedures, services, equipment, and supplies provided to patients on behalf of both the physician and the outpatient facility.

After passing the COC exam, employers will recognize your mastery of outpatient hospital coding, including working knowledge of ambulatory payment classifications (APCs), payment status indicators, and Medicare severity-diagnosis-related groups (MS-DRGs). Coders who earn their COC credential go on to report outpatient services in a variety of settings, such as:

  • Hospital Emergency Departments

  • Outpatient Hospital Clinics

  • Outpatient Therapy Departments

  • Outpatient Cancer Centers

  • Dialysis Services

  • Outpatient Radiology Departments

  • Ambulatory Surgery Centers

Who should take the COC exam?

After you’ve trained with AAPC to become a medical coder — or if you have substantial medical coding experience — you should register for the COC exam.

Passing the COC exam elevates your earning potential. As this certification requires expertise in multiple payment systems, COCs are well compensated, earning an average salary of $62,846 per year, which makes the COC one of the highest paid core credentials. If you're thinking about becoming a certified outpatient coder, you can learn more about COC salaries in your area with our salary calculator.

What to expect on exam day

The exam has a total of 100 questions with a minimum of 70 to be answered in four hours. People often wonder if the COC exam is hard. We'll say this: If you have taken the training course, studied, and are familiar with your CPT®, ICD-10-CM, and HCPCS Level II code books, the test will be demanding, but not difficult.

Here's a quick overview of what you can expect:

Before you begin the test, take a moment and breathe. You have prepared for this. You have your code books by your side and you know how to use them. This is your opportunity to demonstrate your coding expertise.

You'll have four hours to finish the exam, giving you approximately 2.4 minutes to answer each of the 100 multiple-choice questions. You can save time by reading the answer choices before reading each question and by saving the more difficult questions for last. It’s important to answer every question, even if you aren’t sure. Your best guess is better than no answer at all.

The questions assess several areas of knowledge, most of which are presented as coding scenarios to test application of CPT® procedure codes, HCPCS Level II procedure and supply codes, and ICD-10-CM diagnosis codes. The end of the exam has 10 cases that test the ability to read and accurately code a medical record.

You will be able to reference approved medical code books during the exam — the AMA's CPT® Professional Edition, as well as your choice of ICD-10-CM and HCPCS Level II code books. To be clear, these are the only code books you are allowed to use.

For in-person exams

When you register for the COC exam, you will be given detailed instructions on where the test will be taken, what time you should arrive, and what you need to bring.

You should arrive at your exam location 30 minutes early. Be sure to bring all necessary items (photo ID, #2 pencils, an eraser, code books, etc.) and listen carefully as the proctor provides instructions. You will then have the chance to ask any questions. If you are confused or concerned about anything, it’s important to clarify. After all, someone else might be wondering the same thing.

Location: Local chapter or licensed instructor site
Exam format: 100 multiple-choice questions
Time allowed: 4 hours
Proctor to examinee ratio: 1 to 25
Cancellation fee: Must be canceled 21 days prior exam date, service charge of $100
Reschedule fee: Must be rescheduled 21 days prior exam date, service charge of $100
No show fee: $100

 Schedule now

For electronic exams

Our electronic exam is a four-hour live remote proctored examination completed in one sitting and proctored by Examity). After purchasing or transferring your current exam voucher, you’ll receive a Notice to Schedule from our partner Meazure Learning (formerly Scantron) and will be able to schedule your exam for a date and time convenient to you. On the day of the exam, you will log into your Meazure Learning account, then connect with your Examity proctor to complete a security check and take your exam. Your results will be posted within 7-10 business days from the date you complete your exam.

*Electronic exams taken outside of the US will be proctored at a local Testing Center. Please refer to the Test Center FAQs or ask your Career Counselor for more information.

Equipment required: Reliable internet connection and an external webcam that can be positioned to show your face, hands, keyboard, and the area around the keyboard (about 10 inches)
Location: At home in a quiet, private location
Exam format: 100 multiple-choice questions delivered in one sitting
Time allowed: 4 hours
Proctor to examinee ratio: 1 to 2
Cancellation fee: No fee charged if cancelled 24 hours in advance
Reschedule fee: No fee charged if rescheduled 24 hours in advance
No show fee: If you do not show up to your scheduled exam OR you do not meet the requirements to take the exam, your exam voucher will be cancelled, and you will need to purchase a new voucher in order to take the exam.

Availability: Schedule now

Passing grades

An overall score of 70% or higher is required to pass the certification exam. For a passing score of 70%, you must get at least 70 questions correct. If you incorrectly answer more than 30 questions, you will not pass. If you don’t pass, you will be notified of the categories/areas of study with sub-scores of 65% or less to help you prepare for retesting.

All AAPC certification exams exclusively measure proficiencies relating to the one credential named in the exam. To earn additional medical coding credentials, you will be required to pass additional certification exams.

Your results will be shared with you online in your My AAPC Account Dashboard under My Exams. You can expect the results within 7-10 business days after taking the exam. Once you have passed, your certificate will be sent to you in the mail.

Materials allowed on the day of the exam

Approved code books

Note: Code sets are updated annually, so it’s essential to use the current calendar year's code books when taking the COC certification exam.

Any officially published updates (errata) for the above code books may also be used.


Manual calculators are allowed on all exams (no smartphones, tablets, or smart watches). For electronic exams, an online calculator will be included for use during the exam.

Book notes

Handwritten notes are acceptable in the code books only if they pertain to daily coding activities. Long passages of information are not permitted on the blank pages. Questions from the study guides, practice exams, or the exam itself are prohibited. Altering, whiting out, painting, or printing over any pages within the code books (e.g., marketing pages, table of contents, reference pages, etc.) to supplement information is prohibited.

Book tabs

Tabs may be inserted, taped, pasted, glued, or stapled in the code books so long as the obvious intent of the tab is to earmark a page with words or numbers, not supplement information in the book.

NOTE: Electronic devices with an on/off switch (phones, tablets, etc.) are not allowed into the examination room. Failure to comply with this policy may result in disqualification of your exam.

Breakdown of the 100-question COC exam

Passing the COC exam requires you to correctly answer a minimum of 70 questions from the domains below. The exam will rely on a level of understanding that enables you to identify the domain.

Medical terminology (7 questions)
These questions will assess your knowledge of medical terminology for all systems in the human body.

Anatomy (7 questions)
These questions will assess your knowledge of anatomy for all systems in the human body.

Coding guidelines (3 questions)
This section will address the ICD-10-CM Official Guidelines for Coding and Reporting, CPT® coding guidelines and parenthetical notes, and modifier use.

Payment methodologies (13 questions)
This section will test your knowledge of payment methodologies which pertain to services covered under Medicare Parts A, B, C, and D; Medicare as secondary payer; OPPS and IPPS payment methodologies; and UB-04 and CMS-1500 claim form completion requirements.

Compliance (3 questions)
This section will address NCDs/LCDs, HIPAA, and ABNs.

ICD-10-CM (15 questions)
This area will test your proficiency in diagnosis coding within all the chapters of ICD-10-CM, as well as thorough knowledge of the ICD-10-CM Official Guidelines for Coding and Reporting. Additionally, diagnosis questions will appear in other sections of the exam from the CPT® categories.

HCPCS Level II (7 questions)
This section will test your knowledge on HCPCS Level II coding and includes questions focusing on modifiers, supplies, medications, and professional services for Medicare patients.

CPT® (13 questions)
This section will test your knowledge of CPT® coding for evaluation and management, surgery, radiology, pathology/laboratory, and medicine procedures and services.

Surgery and modifiers (22 questions)
This part of the exam will test your proficiency related to procedures approved for outpatient hospital and ASC facilities.

Cases (10 cases, 1 question each)
Each case will test your ability to accurately code medical record documentation using CPT®, ICD-10-CM, and HCPCS Level II codes.