AHIMA CCS-P Exam Prep
Prep for AHIMA's Certified Coding Specialist – Physician-based (CCS-P) exam starts here: a free, original practice set mapped to the current content outline (effective May 1, 2024), an 8-week study plan, and the 2026 code book rules that decide whether you're allowed to test at all.
Free CCS-P practice set: 30 original items
Unofficial practice written by Castleport Test Prep. These are fictional learning cases, not AHIMA exam questions; your score here is feedback on these 30 items, not a predicted CCS-P result.
Choose one answer for items 1–27.
Domain 1: Diagnosis coding
1. A family physician sees an established patient for four days of cough and a temperature of 101.2°F. Assessment: "Probable community-acquired pneumonia. Chest X-ray ordered." No other diagnosis is documented. Which ICD-10-CM code(s) belong on the claim for this office visit?
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Answer: B. In outpatient and physician settings, a diagnosis documented as probable, suspected or "rule out" isn't coded. You code the signs and symptoms to the highest degree of certainty for the encounter: cough (R05.9) and fever (R50.9). Coding uncertain diagnoses as if confirmed (A, C) is an inpatient rule that doesn't apply to office visits. Z03.89 is for an encounter where a suspected condition is ruled out and the patient has no signs or symptoms, which isn't this patient.
Sources: ICD-10-CM Official Guidelines FY2026, Sections IV.H and I.C.21.c.6.
2. The physician documents type 2 diabetes mellitus and chronic kidney disease, stage 3a. The note doesn't say whether the conditions are related. Which codes are correct?
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Answer: A. The word "with" in the Alphabetic Index presumes a link between diabetes and CKD unless the provider clearly documents that the conditions are unrelated, so the combination code E11.22 applies. E11.22 carries a "use additional code" note for the CKD stage, so N18.31 is added. B and D miss the presumed link; C drops the required stage code.
Sources: ICD-10-CM Official Guidelines FY2026, Section I.A.15; FY2026 Tabular List and Index, E11.22 and N18.31.
3. A patient is treated for hypertension and heart failure. The physician doesn't specify the type of heart failure or link the two conditions. Which codes apply?
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Answer: D. ICD-10-CM presumes a causal relationship between hypertension and heart failure unless the provider documents that they are unrelated, so I11.0 (hypertensive heart disease with heart failure) is assigned, plus a code from I50.- for the type of heart failure: I50.9 when the type isn't specified. I10 is wrong because the presumed link moves the case out of essential hypertension. C omits the heart failure code that I11.0 instructs you to add.
Sources: ICD-10-CM Official Guidelines FY2026, Section I.C.9.a.1; FY2026 Tabular List, I11.0 and I50.9.
4. An average-risk 52-year-old comes in for a screening colonoscopy. The gastroenterologist finds and removes a sigmoid colon polyp; pathology is pending. What is the first-listed diagnosis for the professional claim?
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Answer: B. Screening was the reason for the encounter, so the screening Z code is first-listed. A condition found during the screening is added as an additional diagnosis, here K63.5 for the colon polyp (a polyp later confirmed as an adenoma would go to D12.- instead). A demotes the reason for the encounter. Z12.12 is screening of the rectum, not the colon. Z80.0 (family history) isn't documented and this patient is average risk.
Sources: ICD-10-CM Official Guidelines FY2026, Section I.C.21.c.5; FY2026 Tabular List, Z12.11, K63.5 and D12.-.
5. A patient returns four weeks after treatment of a closed fracture for a routine check. The fracture is healing normally. How is the fracture reported for this visit?
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Answer: A. Seventh character D covers encounters after active treatment is complete, when the patient gets routine care during healing or recovery. Option B, 7th character A, is for active treatment. ICD-10-CM tells you not to use aftercare Z codes for injuries; the injury code with the right 7th character does that job, so C is wrong. Z09 is for follow-up after a condition has been fully treated and no longer exists.
Sources: ICD-10-CM Official Guidelines FY2026, Sections I.C.19.a, I.C.19.c.1 and I.C.21.c.7–8.
6. In the ICD-10-CM Tabular List, an Excludes1 note under a code means:
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Answer: B. Excludes1 means "not coded here": the two conditions can't occur together, so you don't report both. The exception is when the two conditions are unrelated to each other. A describes Excludes2. C and D describe "code first" and "use additional code" notes.
Sources: ICD-10-CM Official Guidelines FY2026, Section I.A.12.a.
Domain 2: Procedure coding
7. An established patient's office visit has low medical decision making (MDM). The physician documents 42 minutes of medically necessary, qualifying physician time on the date of the encounter, excluding time for separately reported services. Which E/M code is supported?
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Answer: C. Office and outpatient E/M levels are selected by MDM or by total practitioner time on the date of the encounter, whichever the documentation supports. Low MDM alone supports 99213 (A), but 42 minutes meets the 40-minute threshold for 99215. B undercounts the time, and D adds modifier 25 without a documented reason.
Sources: CMS MLN, Evaluation and Management Services Guide (May 2026), pp. 15 and 22–24; CMS RVU26D, 99213–99215 descriptors.
8. Dr. Ames, a family physician, sees a patient for the first time. Two years ago the patient saw Dr. Brooks, also a family physician, in the same group practice. Both physicians practice the exact same specialty and subspecialty. How is today's visit reported?
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Answer: D. A new patient is one who hasn't received professional services from the physician, or from another physician of the exact same specialty and subspecialty in the same group, within the past three years. The window is three years, not one (C), and it's the group and specialty that count, not the individual physician (A) or chart review (B).
Sources: CMS MLN, Evaluation and Management Services Guide (May 2026), p. 23; AMA CPT office E/M guidelines, p. 15 (effective January 1, 2021).
9. During an established Medicare patient's diabetes follow-up, which has its own separately documented moderate-complexity MDM, the physician also removes three skin tags (CPT 11200). How should the services be reported?
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Answer: A. Skin tag removal is a minor procedure with a global period, and the decision to perform it is included. A significant, separately identifiable E/M on the same day is reported with modifier 25, which goes on the E/M code, not the procedure (C). Modifier 57 (D) is for the decision for a major surgery. B loses a separately documented service.
Sources: CMS MLN, Global Surgery Booklet (December 2025), p. 10; CMS RVU26D, PPRRVU2026_Oct_nonQPP.csv, 11200, global period 010.
10. A surgeon sees a Medicare patient in the office and makes the initial decision for a total knee arthroplasty (90-day global) to be performed the next day. Which modifier goes on the E/M?
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Answer: C. Modifier 57 identifies an E/M on the day before or the day of a major surgery that resulted in the initial decision to operate. The modifier identifies this separately reportable visit. Modifier 25 identifies a significant, separately identifiable E/M with another same-day procedure or service. Modifier 24 is for an unrelated E/M during a postoperative period, and modifier 79 is for an unrelated procedure during a postoperative period.
Sources: CMS MLN, Global Surgery Booklet (December 2025), pp. 9–10 and 13.
11. A Medicare NCCI procedure-to-procedure edit for two codes has a modifier indicator of 0. What does that mean for the coder?
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Answer: A. Indicator 0 means no modifier is allowed to bypass the edit. Indicator 1 is the one that permits an NCCI-associated modifier when clinically appropriate (B). Indicator 9 means the edit doesn't apply. Modifier 25 does not bypass this indicator-0 edit.
Sources: CMS NCCI Policy Manual, 2026 Chapter I, Section E, pp. I-14–16; CMS MLN1783722, Proper Use of Modifiers 59, XE, XP, XS and XU (April 2026), p. 3.
12. In the office, a nurse gives an intramuscular injection of 1 g ceftriaxone ordered by the physician. HCPCS J0696 is ceftriaxone sodium, per 250 mg. Which codes and units describe the drug and administration?
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Answer: D. Drug units follow the HCPCS descriptor: 1 g is 1,000 mg, and 1,000 ÷ 250 = 4 units. The IM injection is reported with 96372. A undercounts units. C is the IV push code, but this was intramuscular. B leaves off the administration.
Sources: CMS January 2026 HCPCS file, J0696; AMA, CPT code 96372; CMS RVU26D, 96372 and 96374 descriptors.
13. A Medicare patient's screening colonoscopy becomes therapeutic when the physician removes a polyp by snare. Which modifier tells Medicare the service began as a colorectal cancer screening?
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Answer: D. Medicare uses modifier PT on the CPT code when a colorectal cancer screening test becomes diagnostic or therapeutic. Modifier 33 is CPT's general preventive-services modifier, not Medicare's indicator for this situation. 53 is a discontinued procedure. GA reports a required ABN issued for the service and kept on file.
Sources: Noridian, modifier PT guidance, Correct Use; CMS Medicare Advance Written Notices of Non-coverage, p. 11 (GA).
Domain 3: Research
14. A Medicare claim for the same outpatient test and diagnosis is paid in one state but denied in another. Which coverage-policy difference could explain this result?
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Answer: D. LCDs are written by Medicare Administrative Contractors (MACs) and apply only within the MAC's jurisdiction, so coverage rules for the same test can differ by region. NCDs apply nationwide (A). CPT Assistant isn't state-specific (C), and NCCI edits are national (B).
Sources: CMS, Medicare coverage of items and services, NCD and LCD sections.
15. Which publication does the AMA describe as its official source for CPT coding guidance?
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Answer: A. The AMA publishes CPT Assistant as its official CPT guidance. Coding Clinic is the American Hospital Association's publication for ICD-10-CM and ICD-10-PCS. The NCCI Policy Manual and Claims Processing Manual are CMS documents for Medicare coding and claims; neither is the AMA's CPT guidance publication.
Sources: AMA, CPT content in action (July 1, 2025), p. 16; AHA Central Office, publication scope.
16. Your clinic's EHR uses natural language processing (NLP) to scan notes. It flags a visit and automatically sends the physician this alert: "Clinical indicators suggest malnutrition. Add malnutrition to the assessment? Yes / No." Malnutrition isn't documented anywhere in the record. How should the coding team treat this alert?
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Answer: C. Any communication that puts a specific diagnosis in front of a provider for a specific encounter is a query, whatever the software calls it, and technology-generated queries must meet the same compliance standards as manual ones. A yes/no format can't be used to obtain a new diagnosis that isn't already documented, so this alert fails that standard (A, B). Reviewing the answer afterward (D) doesn't fix a noncompliant query; the problem is how the question was asked. The CCS-P outline asks you to recognize how NLP and computer-assisted coding are used; the practical rule is that their output still needs human validation.
Sources: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice, 2026 Update, pp. 12 and 22–24.
Domain 4: Compliance
17. A patient's lab results show a low sodium level and the physician ordered sodium chloride tablets, but no related diagnosis is documented. Which query is compliant?
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Answer: D. A compliant query lays out the clinical indicators and lets the provider choose among clinically reasonable options, plus an "other" option so they can give a different explanation. "Unable to determine" is an acceptable added option. A steers the provider to one answer. C mentions risk-score impact; queries must not mention reimbursement, quality measures or similar reporting effects. B uses a yes/no format to get a diagnosis that isn't documented, which isn't allowed in any setting.
Sources: ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice, 2026 Update, pp. 8 and 10–12.
18. Before a service, the office gives a Medicare fee-for-service patient a valid Advance Beneficiary Notice because it expects Medicare to deny the service as not reasonable and necessary for this patient. The patient chooses to receive the service and have Medicare billed, then signs the ABN. Which modifier goes on the claim line?
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Answer: A. GA reports that a required ABN is on file. GZ means a denial is expected as not reasonable and necessary but no required ABN was obtained, leaving the provider responsible if Medicare denies on that basis. GX is for a voluntary ABN on a statutorily excluded service, and GY flags a statutorily excluded service.
Sources: CMS MLN006266, Medicare Advance Written Notices of Non-coverage (May 2025), pp. 3 and 10–12.
19. A Medicare patient who has never been seen at the practice has a first visit with the practice's physician assistant. Dr. Lee is in the office suite the whole time but doesn't see the patient. How should the visit be billed?
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Answer: B. Billing this PA visit incident-to a physician requires an initial physician service and continuing physician involvement in the course of treatment. A brand-new patient hasn't had that initial physician service, so supervision alone doesn't make the visit incident-to (A, C). The PA bills under their own NPI. The PA fee-schedule allowance is 85% of the physician amount; normal deductible and coinsurance rules still apply.
Sources: CMS, Incident-to services and supplies; Medicare Benefit Policy Manual, Chapter 15, Sections 60.1–60.3; CMS, Physician Assistants, payment section.
20. Which signature on a physician's progress note will Medicare not accept?
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Answer: C. Medicare doesn't accept stamped signatures, with a narrow exception for a documented physical disability that prevents the author from signing. Handwritten and valid electronic signatures are accepted. A valid attestation by the record's author can address a missing signature on a progress note; it cannot substitute for a required order signature or backdate a plan of care. The same guidance covers scribes, including AI scribe tools: the practitioner signs the entry to authenticate it.
Sources: CMS Medicare Program Integrity Manual, Chapter 3, Section 3.3.2.4; CMS MLN905364, Complying with Medicare Signature Requirements (July 2025), p. 2.
21. The HIPAA minimum necessary standard does NOT apply to which use or disclosure?
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Answer: C. Disclosures to or requests by a health care provider for treatment are exempt from minimum necessary. Payment (A) and health care operations, including business associates and audits (B, D), are still limited to the minimum necessary information.
Sources: HHS, Minimum Necessary Requirement, How the Rule Works; 45 CFR 164.502(b)(2)(i).
22. A physician provides a telehealth visit to a patient who is at home. Which place-of-service code describes this location?
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Answer: B. POS 10 is telehealth provided in the patient's home. POS 02 is telehealth provided somewhere other than the patient's home. POS 11 is the office and POS 22 is an on-campus outpatient hospital department. Payer rules for which POS and modifiers to report on telehealth claims vary, so check the payer, but the code descriptions don't.
Sources: CMS Place of Service Code Set, entries 02, 10, 11 and 22.
Domain 5: Revenue cycle
23. Use these made-up values: work RVU 1.92, practice expense RVU 1.60, malpractice RVU 0.13; GPCIs: work 1.000, practice expense 1.050, malpractice 0.900; conversion factor $33.00. What is the Medicare fee schedule amount?
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Answer: C. Multiply each RVU by its own GPCI, add the three results, then multiply by the conversion factor: (1.92 × 1.000) + (1.60 × 1.050) + (0.13 × 0.900) = 1.92 + 1.68 + 0.117 = 3.717; 3.717 × $33.00 = $122.66. A uses only the work RVU. B skips the GPCIs. D forgets to adjust the malpractice RVU. The numbers here are illustrative, not current Medicare values.
Sources: CMS, PFS Documentation and Files, payment formula.
24. Medicare's participating fee schedule amount for a physician service subject to the federal limiting-charge rule is $150.00. What is the federal limiting charge for a non-participating physician's unassigned claim?
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Answer: C. The non-participating fee schedule amount is 95% of the participating amount ($142.50), and the limiting charge is 115% of that: $142.50 × 1.15 = $163.875, rounded to $163.88. A is what Medicare recognizes for a non-par physician, not the charge cap. D applies 115% to the participating amount.
Sources: CMS, PFS Documentation and Files, participating, non-participating and limiting-charge amounts.
25. A remittance advice shows a $40 adjustment with group code CO and reason code 45 (charge exceeds the fee schedule or contracted amount). What should the practice do with the $40?
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Answer: B. Group code CO (contractual obligation) assigns the amount to the provider under the contract or regulation, so it can't be billed to the patient. Amounts the patient owes come back with group code PR. Nothing here suggests a coding error to appeal.
Sources: X12 Claim Adjustment Group Codes, CO and PR; X12 Claim Adjustment Reason Codes, 45; CMS, Remittance Advice Resources and FAQs, p. 2.
26. A Medicare Advantage patient has a chronic condition that maps to an HCC. It was documented and coded last year, but no qualifying encounter this calendar year addresses it. Can last year's diagnosis automatically be reused as this calendar year's diagnosis data for risk adjustment?
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Answer: A. Risk adjustment diagnoses must come from acceptable encounters with acceptable provider types. A diagnosis does not automatically carry forward into another data-collection period because a condition is chronic. Medicare Advantage uses a prospective model: CMS's 2026 midyear and final risk scores use diagnoses from 2025. C and D supply no qualifying current-period documentation; B would improperly reuse an earlier period's data.
Sources: CMS CY2026 Risk Adjustment Implementation Information (September 29, 2025), p. 7; Medicare Managed Care Manual, Chapter 7, Sections 70 and 120.1.1.
27. An office bills 99213 for hypertension follow-up and a urinalysis for new dysuria. Hypertension is listed as diagnosis A and dysuria as diagnosis B in item 21 of the CMS-1500 (version 02/12). How should item 24E be completed?
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Answer: D. Item 24E holds diagnosis pointer letters that link each service line to the diagnosis in item 21 that supports it. The urinalysis is supported by dysuria, not hypertension (A). 24E takes letters, not codes (C), and a missing pointer can get the line rejected (B).
Sources: CMS Medicare Claims Processing Manual, Chapter 26, Section 10.4, items 21 and 24E, pp. 15–17.
Medical scenarios: select all that apply
Items 1–27 are traditional multiple choice with one best answer. Items 28–30 use the format AHIMA describes for its medical-scenario sections, multiple-choice, multiple-response: select every code that belongs on the claim. Code years match the 2026 books the exam requires.
28. Evaluation and management. A new patient sees an internist to establish care. The patient has type 2 diabetes with hyperglycemia, managed with metformin, and essential hypertension. The physician assesses and manages both conditions. Metformin is documented as long-term current therapy. The physician documents moderate MDM and 48 minutes of qualifying physician time on the date of service, excluding separately reported services. Select every code that should be reported.
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Answer: 99204, E11.65, Z79.84, I10. This is a new patient, so 99214 is out. Moderate MDM supports 99204, and so does 48 minutes, which meets the 45-minute threshold but not the 60 minutes needed for 99205. E11.65 captures diabetes with hyperglycemia, which is more specific than E11.9. Z79.84 reports long-term use of oral hypoglycemic drugs; Z79.4 is for insulin, which isn't documented. I10 reports essential hypertension, since no heart or kidney involvement is documented.
Sources: CMS MLN Evaluation and Management Services Guide (May 2026), pp. 22–24; CMS RVU26D, 99204–99205 descriptors; ICD-10-CM Official Guidelines FY2026, Sections I.C.4.a.3 and IV.J; FY2026 Tabular List, E11.65, Z79.84 and I10.
29. Surgery. A dermatologist excises a lesion from a patient's back with 0.3 cm margins on each side and closes the wound with a single-layer (simple) closure. The lesion's diameter before excision was 1.2 cm. Pathology: benign compound nevus. Select every code that should be reported.
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Answer: 11402, D22.5. The excised diameter is the lesion plus the narrowest margins on both sides: 1.2 + 0.3 + 0.3 = 1.8 cm, which falls in the 1.1–2.0 cm band for a benign lesion of the trunk (11402). 11401 covers an excised diameter of 0.6–1.0 cm, and 11403 starts at 2.1 cm. Simple repair is included in the excision, so 12001 isn't reported. D22.5 is a melanocytic nevus of the trunk; D48.5 is for uncertain behavior, which the benign pathology rules out, and L82.1 is seborrheic keratosis.
Sources: CMS NCCI Policy Manual, 2026 Chapter III, Section E.6, p. III-7; Novitas Billing and Coding Article A57113, Coding Guidance; CMS RVU26D, 11401–11403 descriptors; FY2026 Tabular List and Index, D22.5.
30. Medicine. A patient reports palpitations. The office performs a 12-lead ECG on its own equipment, and the physician interprets it and writes the report. No arrhythmia is identified. Select every code that should be reported.
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Answer: 93000, R00.2. 93000 is the complete routine ECG: tracing plus interpretation and report. Since the office did both, 93005 (tracing only) and 93010 (interpretation only) aren't added on top. 93040 is a 1–3 lead rhythm ECG. With no arrhythmia found, the symptom code R00.2 (palpitations) is the reason for the test; I49.9 would claim an arrhythmia that wasn't diagnosed, and R07.9 (chest pain) isn't documented.
Sources: CMS RVU26D, 93000, 93005, 93010 and 93040 descriptors; California DHCS Cardiology manual, pp. 1–3 (code descriptions and components); CMS NCCI Policy Manual, 2026 Chapter I, component-code principle; ICD-10-CM Official Guidelines FY2026, Section IV.D; FY2026 Tabular List, R00.2, I49.9 and R07.9.
How to use your result
Count items 1–27 one point each, and give items 28–30 a point only if you picked every correct code and nothing else. Then group your misses by domain:
- Two or more misses in one domain: that domain goes first in the study plan below.
- Misses spread across domains: check whether the misses came from missing rules, source lookup, or process errors such as overlooking documentation, instructional notes or units.
- Mostly scenario misses: practice full-record coding from operative notes and office notes with a timer, not just one-line questions.
Thirty items can't tell you whether you'll pass. They tell you where to aim the next few weeks. The domain groups have different numbers of items—6 diagnosis, 7 procedure, 3 research, 6 compliance and 5 revenue-cycle items, plus 3 medical scenarios—so a small domain score is not a precise ranking of your strengths.
Keep an error log. For every miss, from this set or any other practice, write one row. Rewriting the corrected reasoning in your own words, then retrying the item a few days later without looking, is what turns a miss into a rule you keep.
| Item | Domain | What I chose | Why it was wrong | Rule and where it lives | Retry date |
|---|---|---|---|---|---|
| 12 | Procedure coding | A (96372, J0696 × 1) | Counted the vial, not the 250 mg billing unit | HCPCS descriptor sets the unit: 1,000 mg ÷ 250 mg = 4 | 3 days later |
Useful error types to tag: documentation missed, rule not known, wrong source or year, lookup error, modifier, units or math, rushing.
Where CCS-P points come from
The exam has 121 items, 97 scored and 24 unscored pretest items, with 3 hours 55 minutes for instructions and examination inside a 4-hour appointment. Scores run from 100 to 400 and 300 passes. You must bring three 2026 code books from AHIMA's approved list (ICD-10-CM, the AMA CPT Professional Edition and HCPCS Level II) or you can't test.
| Domain (2024 outline) | Weight | Published item range | What to drill first |
|---|---|---|---|
| 1. Diagnosis coding | 24–26% | 23–25 | ICD-10-CM conventions, outpatient Section IV rules, chapter guidelines for diabetes, hypertension, injuries and Z codes |
| 2. Procedure coding | 28–32% | 27–31 | E/M for all categories, CPT surgery and medicine guidelines, CPT/HCPCS modifiers, NCCI edits |
| 3. Research | 6–10% | 6–10 | Federal, state and payer rules; which source governs (LCD, NCD, CPT Assistant, Coding Clinic); computer-assisted coding and NLP |
| 4. Compliance | 18–22% | 17–21 | Compliant queries, signatures, audits, HIPAA, place of service, incident-to, ABNs, provider education |
| 5. Revenue cycle | 14–18% | 14–17 | Clean-claim data, remittance responses, RBRVS payment math, diagnosis-to-procedure linking, HCCs and risk adjustment, denial types |
| Medical scenarios | — | — | Split evenly across evaluation and management, surgery and medicine |
Procedure coding and compliance together carry about half the weight. Medical scenarios cover E/M, surgery and medicine. If your daily work is mostly diagnosis coding or one specialty, give procedure coding and compliance time in your plan.
Sources: AHIMA CCS-P specifications, timing FAQ, 2024 content outline and crosswalk, Table 1. The item ranges are published by AHIMA, not calculated from rounded percentages. The scenario categories are not an additional set of domain weights.
Your 8-week CCS-P study plan
This plan assumes about 8–10 hours a week and some working coding experience. With less experience, stretch each week into two. These are editorial suggestions, not an AHIMA requirement, and the hours aren't a promise of readiness. At 8–10 hours a week, the eight-week plan totals 64–80 hours.
Each one-hour session: 10 minutes recalling last session's rules without notes, 30 minutes coding from your exam books, 15 minutes reviewing misses, 5 minutes adding rules and sources to your error log. Coding from the actual books every time makes finding things in them automatic.
| Week | Focus | Do this |
|---|---|---|
| 1 | Baseline and books | Take the 30 items above untimed. Read the CCS-P content outline task by task. Confirm your three 2026 books against AHIMA's list. Read ICD-10-CM Section I.A–B and Section IV. |
| 2 | Diagnosis coding | Chapter guidelines that dominate physician coding: diabetes, hypertension, neoplasms (table use), injuries and 7th characters, pregnancy basics, Z codes. Rework items 1–6 and the diagnosis portions of items 28–30, then check the examples in Sections I and IV of the official guidelines. For each answer, trace the Index entry and Tabular instructions. |
| 3 | E/M | Office E/M by MDM and by time, new vs. established, and the other E/M categories the outline covers (hospital, emergency department, nursing facility, home). Modifiers 24, 25 and 57. Rework items 7–10 and 28, then compare the relevant categories in the CMS E/M guide and your CPT book. |
| 4 | CPT surgery | Surgery section guidelines and the global package. Integumentary sizing and repairs, fracture care, endoscopy. NCCI procedure-to-procedure edits and modifier indicators. Rework items 9–11, 13 and 29; explain each modifier choice and the lesion-size calculation before checking the answer. |
| 5 | Medicine, radiology, lab, HCPCS | Professional vs. technical components (26/TC), injections and infusions, vaccines, ECG, HCPCS Level II drug units and supplies. Rework items 12 and 30; find the administration, drug-unit and component-code instructions in your books. Review the related medicine, radiology and laboratory guidelines. |
| 6 | Compliance | Compliant queries (including technology-generated prompts), signature rules including AI scribes, incident-to, ABNs and G-modifiers, HIPAA, place of service, audit sampling and provider education. Rework items 16–22 and record the exact source section behind each answer. |
| 7 | Revenue cycle and research | RBRVS math, par vs. non-par, claim data elements, remittance codes and denial types, HCCs and risk adjustment, LCDs and NCDs, which source governs, computer-assisted coding. Rework items 14–16 and 23–27. Recalculate the payment examples without reading the explanations, then check units, dates and rounding. |
| 8 | Timed practice and logistics | Work the 30 items on this page in a 55-minute drill, then review every miss against the book. These familiar items test your review process; the drill is not a full-length exam simulation. If you already have a suitable original 121-item set, a full-length rehearsal is optional: allow 3 hours 55 minutes for instructions and questions. Final code book check. Confirm your test center and ID. |
Apply once you're nearly ready, not at the start: once AHIMA approves your application you get 120 calendar days to schedule and test, and its Candidate Guide says that window isn't meant for studying.
Code books: what to bring to the test center
Exams delivered on or after May 1, 2026 require books from AHIMA's 2026 CCS-P code book list. Test center staff check ISBNs. Arrive without the correct books and you won't test, and you'll forfeit the fee.
You must bring all three:
- One 2026 ICD-10-CM book from the approved list. Eleven versions are approved, from AHIMA, AMA, Elsevier (Buck's), Optum360, AAPC, Decision Health and PMIC. Check the exact title and binding against the list, because several publishers have more than one edition and not every version is approved.
- AMA CPT 2026 Professional Edition (ISBN 978-1-64016-322-5), or the AMA CPT Professional 2026 and CPT QuickRef App bundle (ISBN 978-1-64016-332-4). No other CPT edition is on the list. The bundle's listing does not authorize app or device use in the testing room.
- One 2026 HCPCS Level II book from the approved list. Six versions are approved, from AMA, Optum360, Elsevier (Buck's), AAPC and Decision Health.
What can be in your books (per AHIMA's Candidate Guide, printed p. 13):
- Handwritten notes are allowed, but they must not contain coding rules or guidelines from other reference materials such as Coding Clinic or CPT Assistant.
- No sticky notes or loose papers.
- No handmade tabs.
- Personal calculators aren't allowed in the testing room, so practice RBRVS and unit math without relying on your own calculator.
Before test day, check: the year on every cover reads 2026; each ISBN matches the list; there are no Post-it notes, loose materials or handmade tabs; and your notes do not import coding rules or guidelines from other references.
Pacing: 121 items in 3 hours 55 minutes
That's about 1 minute 57 seconds per item before allowing for instructions. The 3 hours 55 minutes includes reading those instructions. As an editorial pacing guide, aim to finish a first pass by 3 hours 40 minutes on that clock, leaving roughly 15 minutes to revisit flagged items:
| Time elapsed on the instructions/exam clock | Be at about item |
|---|---|
| 1 hour | 33 |
| 2 hours | 66 |
| 3 hours | 99 |
| 3 hours 40 minutes | 121, then review flags |
Short recall items should take well under a minute, which banks time for the medical scenarios. You can move back and forth and flag items, but AHIMA says you must select an answer before moving on, so pick your best answer, flag it and keep going. There are no planned breaks; you can step out, but the clock keeps running. Wrong answers cost nothing extra, so never leave an item unanswered. AHIMA's timing FAQ and exam-format guidance explain the official rules; the checkpoints above are our planning suggestions.
Applying, scheduling and retakes
- Preparation background: AHIMA recommends, but does not require, one of these education, experience or credential routes: a CCS, RHIT or RHIA; a CCA plus one year of multi-specialty coding experience; another organization's coding credential plus one year of multi-specialty experience; two years of multi-specialty coding experience; or specified coursework plus one year of coding experience.
- Fee: $299 for AHIMA members, $399 for non-members. A retake costs the same.
- Where: In person at a Pearson VUE test center, in the U.S. or internationally. AHIMA's online proctored option currently covers only CDIP, CHDA and CHPS, not CCS-P.
- Scheduling window: 120 calendar days from approval. Extensions come in 30-day blocks at $50 each, up to 90 days. Follow the current extension form and Candidate Guide: AHIMA must receive your request at least 14 business days before your scheduled exam date or eligibility end date. Cancel any existing Pearson VUE appointment before the extension can be authorized.
- Rescheduling: AHIMA's written cancellation policy says changes are free at least 15 business days before your appointment and cost $30 from 14 days out to 24 hours before; changes aren't allowed inside 24 hours. Its summary table uses different day wording, so check the charge and deadline Pearson VUE gives for your appointment before confirming a change.
- Test day: Arrive 30 minutes early with a valid primary and secondary ID; both must match the name on your Authorization to Test letter, or you'll be turned away and lose the fee. Staff check your three code books before you enter.
- If you don't pass: Submit a new application and fee. For CCS-P the retest waiting period is 90 days, longer than the 30 days for CCA, CCS, RHIT and RHIA, and AHIMA won't waive it.
Sources: AHIMA CCS-P requirements and fees, certification FAQ and Pearson VUE arrival and ID rules. For the full application walkthrough, see AHIMA exam registration; for retake steps, AHIMA exam retake policy.
How CCS-P scoring works
- Scores are scaled from 100 to 400 and every AHIMA exam sets the pass point at 300. A scaled score isn't a percentage.
- Only the 97 scored items count; the 24 pretest items are mixed in and aren't identified.
- There's no penalty for guessing.
- You get results at the test center right after the exam. The score report shows percent correct by domain, which can help you plan a retake but can't be averaged into your scaled score. AHIMA exam results explains the report in detail.
AHIMA publishes first-time pass rates for the CCS-P:
| Year | First-time testers | First-time pass rate |
|---|---|---|
| 2025 | 357 | 50% |
| 2024 | 394 | 48% |
| 2023 | 314 | 38% |
Roughly half of first-time testers didn't pass in each of the last two published years. That's a reason to prepare deliberately, not a prediction about you. These percentages are rounded and describe first-time testers, so they should not be converted into exact counts of people who passed.
CCS-P questions candidates ask
Do I need the CCS before the CCS-P? No. They're separate credentials. The CCS is AHIMA's hospital-setting coding credential; the CCS-P covers physician offices, group practices, multi-specialty clinics and specialty centers. Holding a CCS is one of AHIMA's recommended (not required) routes into the CCS-P.
Can I take the CCS-P online? Not currently. Pearson VUE lists CCS-P as in person only, at a Pearson test center.
Which code year is tested? The year of the books on AHIMA's current list. The 2026 list took effect for exams on or after May 1, 2026. Real-world ICD-10-CM codes changed again on October 1, 2026, but the exam follows the books on the list, so study from the books AHIMA requires for your appointment date. An announced future list does not change an earlier appointment's requirements.
What happens to my CCA when I pass? AHIMA supersedes the CCA once you pass the CCS or CCS-P, so you stop using it.
How do I keep the credential? Through AHIMA recertification: continuing education units (CEUs) over each two-year cycle plus a recertification fee. See AHIMA certification renewal for the details.
Is this the same as the CCSP security certification? No. CCS-P is AHIMA's physician-based coding credential. CCSP (no hyphen) is an unrelated cloud security certification from ISC2.
Should I take the CPC instead? They cover similar physician-based coding work from different organizations with different formats and rules. If you're weighing the AAPC route, see CPC exam prep and compare the formats side by side before you pay for either.
Related free resources
- AHIMA exam registration: application, fees and Pearson VUE scheduling
- AHIMA exam results: reading your score report and next steps
- AHIMA exam retake policy: waiting periods for every AHIMA exam
- AHIMA certification renewal: CEUs and recertification after you pass
- Medical billing and coding certification: how AHIMA, AAPC and NHA credentials compare
Sources
Exam facts last verified October 22, 2026 against AHIMA's CCS-P page, content outline and crosswalk, 2026 code book list, About the Exams page, Certification FAQs, remote proctoring page and Pearson VUE's AHIMA page. Practice-item rules and the code definitions used here were checked the same day against the sources cited under each item, including the official CMS 2026 data files.
AI tools assisted with drafting and source checks. These checks are not a credentialed professional review. See our editorial standards.
- AHIMA, Certified Coding Specialist – Physician-based (CCS-P): exam format, time, fees, retake policy, eligibility recommendations, pass rates
- AHIMA, CCS-P Examination Content Outline, effective May 1, 2024
- AHIMA, 2024 CCS-P Content Outline Crosswalk: published item ranges per domain
- AHIMA, CCS-P 2026 Required Code Books, effective May 1, 2026
- AHIMA, About the Exams: item types, scaled scoring, no guessing penalty
- AHIMA, Certification FAQs: exam time, eligibility window, extensions, retest waits
- AHIMA, Remote Proctored Exams
- AHIMA, Candidate Guide: code book and test center rules
- CDC/CMS, ICD-10-CM Official Guidelines for Coding and Reporting FY2026
- CMS, Evaluation and Management Services Guide
- CMS, Global Surgery Booklet
- CMS, NCCI Policy Manual for Medicare Services
- CMS, Proper Use of Modifiers 59, XE, XP, XS and XU (MLN1783722)
- CMS, Place of Service Code Set
- CMS, Incident-to services and supplies
- CMS, Medicare Program Integrity Manual, Chapter 3
- CMS, Medicare Advance Written Notices of Non-coverage (MLN006266)
- eCFR, 45 CFR 164.502
- ACDIS/AHIMA, Guidelines for Achieving a Compliant Query Practice, 2026 Update (August 20, 2026)
- CMS, Complying with Medicare Signature Requirements (MLN905364)
- Pearson VUE, AHIMA testing page: delivery mode, arrival and ID
- CMS, National Physician Fee Schedule documentation: payment formula, non-par and limiting charge
- CMS, Medicare coverage of items and services: NCDs and LCDs
- CMS, Medicare Managed Care Manual, Chapter 7: risk adjustment
- Novitas, Billing and Coding Article A57113: lesion excision sizing and measurement
- Noridian, Modifier PT
- CMS, RVU26D official 2026 data: CPT descriptors and global-period indicators; January 2026 HCPCS data: J0696 units; FY2026 ICD-10-CM Tabular and Index: diagnosis-code definitions and instructions
- CMS, Medicare Claims Processing Manual, Chapter 26: item 21 and 24E pointers
- AMA, CPT content in action, p. 16: CPT Assistant as official CPT guidance
- X12, Claim Adjustment Group Codes and Claim Adjustment Reason Codes
- CMS, CY2026 Risk Adjustment Implementation Information, p. 7: diagnosis-data periods and payment-year timing
Castleport Test Prep is an independent publisher. We are not affiliated with, endorsed by or approved by the American Health Information Management Association (AHIMA), its Commission on Certification for Health Informatics and Information Management (CCHIIM), or Pearson VUE. CCS-P, CCS, CCA, RHIT, RHIA and other credential names identify the exams and credentials they refer to; trademarks belong to their respective owners. All practice items on this page are original and are not actual exam questions. Passing practice items doesn't guarantee a passing exam score or employment.
By the Castleport Test Prep Editorial Team.