AAPC - Advancing the Business of Healthcare

Taking the CPB® exam

Take the CPB exam and become a Certified Professional Biller.

The CPB exam is a test of medical billing proficiency consisting of 135 multiple-choice questions that assess several areas of knowledge. The questions require an understanding of the types of insurance plans; local and national coverage determinations (LCDs and NCDs); healthcare regulations such as HIPAA, the False Claims Act, the Fair Debt Collections Act, and Stark Law; the life cycle of a medical claim; denial resolution; medical coding; and more. During the test, you will reference approved code books — the AMA’s CPT® Professional Edition, as well as your choice of ICD-10-CM and HCPCS Level II code books.

Who should take the CPB exam?

After you’ve trained with AAPC to become a medical biller — or if you have substantial medical billing experience — you should take the opportunity to gain certification by registering for the CPB exam.

What to expect on exam day

The exam has a total of 135 questions to be answered in four hours. People often wonder if the CPB 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 know how to use them. This is your opportunity to demonstrate your billing expertise.

You'll have 4 hours to finish the exam, giving you approximately 1.7 minutes to answer each of the 135 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, many of which are presented as scenarios to test application of knowledge about types of insurance plans; local and national coverage determinations (LCDs and NCDs); healthcare regulations such as HIPAA, the False Claims Act, the Fair Debt Collections Act, and Stark Law; the life cycle of a medical claim; denial resolution; medical coding; and more. The exam includes 34 cases that test the ability to read and apply policies. Source documents are provided for the examinee to review.

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 CPB 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: 135 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

Availability: 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: 135 multiple-choice questions
Time allowed: 4 hours
Proctor to examinee ratio: 1 to 2
Cancellation fee: No fee charged if canceled 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 canceled, 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 95 questions correct. If you incorrectly answer more than 41 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 credentials, you will be required to pass additional certification exams.

Your results will be shared with you online in your Account Dashboard under Courses and 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 CPB certification exam.

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

Calculator

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 135-question CPB exam

Passing the CPB exam requires you to correctly answer a minimum of 95 questions from the domains below. The CPB test will rely on a level of understanding that enables you to identify the domain.

Types of insurance (29 questions)
These questions will assess your knowledge of managed care, commercial payers, Medicare, Medigap, Medicaid, Blue Cross/Blue Shield, TRICARE/CHAMPUS, workers’ compensation, and third-party payers (automobile, liability, etc.).

Billing regulations (17 questions)
These questions will address accountable care organizations (ACOs), the National Correct Coding Initiative (NCCI), local coverage determinizations (LCDs), national coverage determinations (NCDs), incident-to billing, global packages, unbundling, completion of the CMS-1500 and UB-04 forms, and payer payment policies.

HIPAA and compliance (7 questions)
This section will test your knowledge of HIPAA privacy, billing compliance, medical record retention, financial policies, and fraud and abuse.

Reimbursement and collections (19 questions)
This section will address RBRVs, payer and patient refunds, provider credentialing, accounts receivable, fair debt, patient statements, patient dismissal, professional courtesy, collection agencies, collections, bankruptcy, payment plans, preauthorizations, claim editing tools, and remittance advice.

Claims and billing (19 questions)
This section will test your knowledge on appeals, denials, claims tracking and follow-up, timely filing, demographics, superbill/encounter forms, retention of records, balance billing, telephone courtesy, electronic claim submission, clean claims, and auditing the billing process.

Coding (10 questions)
This section will assess your knowledge on CPT®, ICD-10-CM, and HCPCS Level II codes and modifiers.

Case analysis (34 questions)
In this section of the exam, source documents are provided for the examinee to review. Examinees will be provided with various policies and must be able to apply those policies. Documents provided include:

  • CMS-1500 claim forms

  • Payment policies

  • Local coverage determinations (LCD)

  • National coverage determinations (NCD)

  • Appeal letters

  • Preauthorizations

  • Accounts receivable reports

  • Claims follow-up reports