Free CPB Practice Test: 50 Billing Questions With Answers

This free CPB practice test has 50 original, unofficial questions for AAPC's U.S. Certified Professional Biller (CPB) exam, with explanations and a topic mix based on AAPC's published domain counts. No signup, and no code books needed for this set.

Question 1 · CPB-01 · Types of insurance

A patient with Original Medicare sees her family doctor in the doctor's office for a sick visit. Which part of Medicare covers the doctor's service?

A. Part A
B. Part D
C. Part B
D. Medigap

Show answer and explanation

Answer: C. Part B

Part B covers services from doctors and other health care providers, plus outpatient care. Part A is mainly inpatient hospital care (plus skilled nursing, hospice and some home health). Part D is drug coverage. Medigap is private supplemental insurance, not a part of Medicare.

Source: Medicare.gov: Parts of Medicare, Part A and Part B sections

Types of insurance (Questions 2–11)

Question 2 · CPB-02 · Types of insurance

Luis is 67, has Medicare because of his age, and still works full time. He has group health coverage through his own job, and his employer has 45 employees. Which plan pays first for his outpatient visits?

A. Medicare, because Luis is over 65
B. The employer group health plan
C. Whichever plan started first
D. Medicare and the group plan split the bill evenly

Show answer and explanation

Answer: B. The employer group health plan

This is the "working aged" rule. When a beneficiary 65 or older has group health coverage through his own or a spouse's current employment, and the employer has 20 or more employees, the group plan pays first and Medicare pays second. Age alone doesn't make Medicare primary, and payer order has nothing to do with which plan started first or with splitting the bill.

Source: CMS Medicare Secondary Payer Manual, Chapter 1, Section 20.1, Working Aged

Question 3 · CPB-03 · Types of insurance

Dana has Medicare. She hurt her back lifting boxes at work, and her employer's workers' compensation carrier accepted the claim. Who should be billed first for treatment of that back injury?

A. Medicare
B. Dana's Medigap policy
C. Dana
D. Workers' compensation

Show answer and explanation

Answer: D. Workers' compensation

Medicare is secondary to workers' compensation for a work-related injury the carrier has accepted. Bill workers' compensation for the care related to that injury. Medigap only supplements Medicare; it doesn't replace the liable payer. Billing Dana first skips the payer responsible for the injury.

Source: CMS Medicare Secondary Payer Manual, Chapter 1, Section 20.4, Workers' Compensation

Question 4 · CPB-04 · Types of insurance

Maya, age 8, is covered under both of her parents' employer plans. Her parents are married and live together. Her mother was born March 14, 1988; her father was born June 2, 1985. Under the birthday rule, which plan is primary for Maya?

A. Her mother's plan
B. Her father's plan, because he is older
C. The plan with the lower deductible
D. The plan that has covered Maya the longest

Show answer and explanation

Answer: A. Her mother's plan

The birthday rule looks only at month and day, not year. March 14 comes earlier in the calendar year than June 2, so the mother's plan is primary. Age, deductible size and length of the child's coverage don't decide it. (If both parents shared a birthday, the plan that has covered the parent longer would be primary.) The birthday rule comes from the NAIC model regulation, which applies where a state has adopted it.

Source: NAIC Coordination of Benefits Model Regulation (MDL-120), Section 6.D(2)(a); definition of birthday, Section 3B

Question 5 · CPB-05 · Types of insurance

A patient has group health coverage through her spouse's employer and also qualifies for Medicaid. Both cover today's visit. How should the practice bill?

A. Bill Medicaid first, then the group plan
B. Bill the group plan first, then Medicaid
C. Bill either one first; the order doesn't matter
D. Bill Medicaid only, because the patient pays less

Show answer and explanation

Answer: B. Bill the group plan first, then Medicaid

Other legally liable coverage must pay before Medicaid does. That's why Medicaid is called the payer of last resort. Bill the group plan first, then send the remaining balance to Medicaid with the primary payer's remittance.

Source: Medicaid.gov: Coordination of Benefits & Third Party Liability, Opening section

Question 6 · CPB-06 · Types of insurance

A military retiree has TRICARE and now works for a private company that provides group health coverage. Which plan pays first for his covered care?

A. TRICARE, because it is a federal program
B. Either plan, at the patient's choice
C. The employer group health plan
D. TRICARE, but only for care at a military facility

Show answer and explanation

Answer: C. The employer group health plan

By law, TRICARE pays after all other health insurance, with a short list of exceptions: Medicaid, TRICARE supplements, state victims-of-crime programs, and certain other federal programs. An employer group plan isn't on that list, so it pays first and TRICARE pays second.

Source: TRICARE: Other Health Insurance, TRICARE pays after other health insurance

Question 7 · CPB-07 · Types of insurance

Ruth just joined a Medicare Advantage plan. She asks whether her Medigap policy will cover her Advantage plan's copays. Which answer is correct?

A. Yes. Medigap pays whatever the Advantage plan doesn't
B. No. Medigap can't be used to pay Medicare Advantage copays, deductibles or premiums
C. Yes, but only if she files with Medigap first
D. Medigap becomes her primary coverage

Show answer and explanation

Answer: B. No. Medigap can't be used to pay Medicare Advantage copays, deductibles or premiums

Medigap supplements Original Medicare. Medicare.gov says plainly that Medigap can't pay a Medicare Advantage plan's copayments, deductibles or premiums. To use Medigap, Ruth would need to be in Original Medicare. Medigap is never primary to Medicare coverage.

Source: Medicare.gov: How Medigap works, Medigap and Medicare Advantage

Question 8 · CPB-08 · Types of insurance

A patient with Original Medicare sees a doctor who accepts assignment. The Medicare-approved amount is $300. The patient still has $100 left on her Part B deductible and owes the standard 20% coinsurance. She has no other coverage. How much does she owe?

A. $140
B. $60
C. $100
D. $160

Show answer and explanation

Answer: A. $140

The deductible comes first: the patient pays $100. That leaves $200 of the approved amount. She owes 20% of that, or $40. Total: $100 + $40 = $140. Medicare's calculated share is $160 before payment adjustments. $60 applies 20% to the full $300 and ignores the deductible. $100 is only the deductible. $160 is Medicare's calculated share before payment adjustments, not hers. (The numbers here are made up for the exercise; real deductibles change each year.)

Source: Medicare.gov: Medicare costs, Part B deductible and coinsurance; CMS: Medicare payment reductions, May 1, 2013, p. 4: payment adjustments are applied after deductible and coinsurance

Question 9 · CPB-09 · Types of insurance

For a service subject to the federal Medicare limiting charge, the participating physician fee schedule amount is $200. A non-participating physician does not accept assignment for this claim. What is the federal limiting charge?

A. $230.00
B. $190.00
C. $200.00
D. $218.50

Show answer and explanation

Answer: D. $218.50

The non-participating Medicare-approved amount is 95% of the participating fee schedule amount: $200 × 0.95 = $190. The limiting charge is 115% of that non-participating amount: $190 × 1.15 = $218.50. $230 applies 115% to the full $200. $190 is the non-participating payment basis, not the charge cap. $200 is the participating amount.

Source: 42 CFR 414.48 (limiting charge), Paragraphs (a)–(b); CMS Physician Fee Schedule Look-Up documentation, Non-participating and limiting charge amounts

Question 10 · CPB-10 · Types of insurance

Omar is in a Medicare Advantage HMO with no point-of-service option. He books a routine mole check with an out-of-network dermatologist, without a referral. It isn't an emergency or urgent care. What is the likely result?

A. The plan generally won't cover it, because HMO members must use network providers outside a few exceptions
B. Original Medicare pays, because the dermatologist accepts Medicare
C. The plan pays at a higher out-of-network coinsurance
D. His Medigap policy pays instead

Show answer and explanation

Answer: A. The plan generally won't cover it, because HMO members must use network providers outside a few exceptions

Medicare Advantage HMO members generally must get care from network providers. The exceptions are emergency care, out-of-area urgent care and temporary out-of-area dialysis. A routine visit isn't one of them, so Omar may have to pay the full cost. Original Medicare doesn't step in for an Advantage member. Some HMOs have a point-of-service option that allows certain out-of-network care for higher cost sharing, but Omar's plan doesn't. Medigap can't be used with Medicare Advantage.

Source: Medicare.gov: Health Maintenance Organization (HMO), What's an HMO?; Questions you may have; Medicare.gov: How Medigap works, Medigap and Medicare Advantage

Question 11 · CPB-11 · Types of insurance

A patient is covered by both TRICARE and Medicaid. Which pays first?

A. Medicaid
B. Either; the patient chooses
C. TRICARE
D. Neither; the claim must be split

Show answer and explanation

Answer: C. TRICARE

TRICARE normally pays after other insurance, but Medicaid is one of its listed exceptions. Medicaid, in turn, pays after other liable coverage. So TRICARE pays first and Medicaid pays last.

Source: TRICARE: Other Health Insurance, TRICARE pays after other health insurance; Medicaid.gov: Coordination of Benefits & Third Party Liability, Opening section

Billing regulations (Questions 12–17)

Question 12 · CPB-12 · Billing regulations

A Medicare NCCI procedure-to-procedure edit pairs two codes billed by the same provider for the same patient on the same date. The edit's modifier indicator is 0. What does that mean?

A. Modifier 59 will bypass the edit
B. No modifier can bypass the edit; the column two code won't be paid with the column one code
C. The two codes aren't actually edited against each other
D. An X modifier will bypass it if the documentation supports it

Show answer and explanation

Answer: B. No modifier can bypass the edit; the column two code won't be paid with the column one code

Indicator 0 means modifiers can't be used to bypass the edit. Indicator 1 is the one that allows a modifier when the circumstances and documentation support it. (Indicator 9 means modifier use isn't specified.) An indicator 0 pair is still an active edit.

Source: CMS NCCI Policy Manual for Medicare Services, Chapter I (2026), Section E, Modifiers and Modifier Indicators, p. I-14

Question 13 · CPB-13 · Billing regulations

What does a Medicare Medically Unlikely Edit (MUE) limit?

A. The number of diagnosis codes on one claim line
B. The number of visits a patient may have in a year
C. The total number of codes on one claim
D. The units of a single code that one provider reports for one patient on one date of service

Show answer and explanation

Answer: D. The units of a single code that one provider reports for one patient on one date of service

An MUE is the maximum number of units of a HCPCS or CPT code that a provider would report for the same beneficiary on the same date of service in almost all correctly reported cases. It doesn't limit diagnosis codes, annual visits or the number of codes on a claim.

Source: CMS: Medically Unlikely Edits, Overview

Question 14 · CPB-14 · Billing regulations

A physician practice bills a nurse's follow-up service "incident to" the physician's service. The service doesn't have a 10-day or 90-day global period. The physician isn't in the office suite but is immediately available through real-time audio and video. Under Medicare's 2026 rules, is the direct supervision requirement met?

A. No. The physician must be physically in the office suite
B. Yes. Real-time audio and video can meet direct supervision for this service
C. Yes, and an audio-only phone call would also be enough
D. Supervision isn't required for incident-to services

Show answer and explanation

Answer: B. Yes. Real-time audio and video can meet direct supervision for this service

Incident-to services must be an integral, though incidental, part of the physician's service and generally require direct supervision. Medicare's current rule lets direct supervision be met by the supervising practitioner's real-time presence through audio and video, but not audio-only. Services with a 010 or 090 global indicator are excluded from that virtual option. The old "physically in the suite" requirement is no longer the only way to meet it.

Source: 42 CFR 410.26 (services incident to a physician's service), Paragraphs (a)(2) and (b); 42 CFR 410.32 (direct supervision), Paragraph (b)(3)(ii)

Question 15 · CPB-15 · Billing regulations

For an Original Medicare patient, a surgeon performs a major procedure with a 90-day global period on April 10. The decision for surgery was already made, and the surgeon sees the patient for a routine pre-op visit on April 9. Is the April 9 visit separately payable?

A. Yes. Pre-op visits are always billed separately
B. Yes, if it's billed with modifier 24
C. No. The day before a major surgery is part of the global period
D. Only if the visit lasts more than 30 minutes

Show answer and explanation

Answer: C. No. The day before a major surgery is part of the global period

Medicare's global package for a major procedure covers the day before surgery, the day of surgery and the 90 days after. A routine pre-op visit the day before is included. Modifier 24 is for unrelated E/M services during the post-op period, not routine pre-op care. Visit length doesn't change the global rule.

Source: CMS MLN Global Surgery booklet (MLN907166), Major procedures (90-day global period)

Question 16 · CPB-16 · Billing regulations

Which statement correctly contrasts the Stark Law (physician self-referral law) with the federal Anti-Kickback Statute?

A. Stark is strict liability; the Anti-Kickback Statute requires knowing and willful conduct
B. Both laws require proof of intent
C. The Anti-Kickback Statute is strict liability; Stark requires intent
D. Neither law applies to Medicaid

Show answer and explanation

Answer: A. Stark is strict liability; the Anti-Kickback Statute requires knowing and willful conduct

HHS-OIG describes Stark as a strict liability law: a prohibited referral is a violation even without intent. The Anti-Kickback Statute is a criminal law that requires knowing and willful conduct. B and C get the intent standards wrong. D is wrong because the Anti-Kickback Statute applies to Medicaid as well as Medicare.

Source: HHS-OIG: Fraud & Abuse Laws, Physician Self-Referral Law; Anti-Kickback Statute

Question 17 · CPB-17 · Billing regulations

A billing manager keeps submitting Medicare claims that the practice's own audit flagged as unsupported. She doesn't check them, reasoning that "the payer will catch any problems." Under the federal False Claims Act, could this count as knowingly submitting false claims?

A. No. Only actual knowledge counts
B. No. The government must prove a specific intent to defraud
C. Yes. Deliberate ignorance or reckless disregard can meet the "knowingly" standard
D. Only if a physician signed the claims

Show answer and explanation

Answer: C. Yes. Deliberate ignorance or reckless disregard can meet the "knowingly" standard

Under the False Claims Act, "knowingly" includes actual knowledge, deliberate ignorance of the truth and reckless disregard of the truth. The statute says no specific intent to defraud is required. Ignoring an audit's red flags is the kind of conduct that standard reaches. Who signed the claim doesn't change the definition.

Source: 31 U.S.C. 3729 (False Claims Act), Subsection (b)(1)

HIPAA and compliance (Questions 18–20)

Question 18 · CPB-18 · HIPAA and compliance

A physician practice sends a patient's medical record to a specialist who is now treating the patient in an otherwise permitted treatment disclosure. Does HIPAA's minimum necessary standard limit this disclosure?

A. Yes. Send only the minimum needed
B. Yes, unless the patient signs an authorization
C. Only the billing portion may be sent
D. No. Disclosures to a health care provider for treatment are exempt from minimum necessary

Show answer and explanation

Answer: D. No. Disclosures to a health care provider for treatment are exempt from minimum necessary

The minimum necessary standard has specific exceptions, and disclosures to (or requests by) a health care provider for treatment are one of them. This exception does not remove separate protections for records such as psychotherapy notes. Minimum necessary still applies to many payment and operations disclosures.

Source: 45 CFR 164.502 (minimum necessary), Paragraph (b)(2)(i); HHS: Treatment, payment and health care operations disclosures, Uses and Disclosures of Psychotherapy Notes; Minimum Necessary

Question 19 · CPB-19 · HIPAA and compliance

A patient asks a practice for a copy of her billing records. Under HIPAA, how long does the practice generally have to act on the request?

A. 30 days after receiving it, with one possible 30-day extension
B. 60 days, with no extensions
C. 10 business days
D. There is no deadline as long as the practice responds eventually

Show answer and explanation

Answer: A. 30 days after receiving it, with one possible 30-day extension

A covered entity must act on an access request within 30 days of receiving it. It can take one extension of up to 30 more days, but only by telling the patient in writing, within the first 30 days, why it needs more time and when it will finish.

Source: 45 CFR 164.524 (right of access), Paragraph (b)(2)

Question 20 · CPB-20 · HIPAA and compliance

During an internal review, a practice confirms Medicare paid it twice for the same service, and it still holds the duplicate payment. The practice doesn't file cost reports and isn't doing any further investigation. After identifying the overpayment, how long does it have to report and return it?

A. 30 days
B. 60 days
C. 1 year
D. Until the Medicare contractor asks for it

Show answer and explanation

Answer: B. 60 days

The overpayment must be reported and returned within 60 days after it's identified. (For providers that file cost reports, the deadline can be the cost report due date if that's later.) An overpayment counts as identified when the provider knowingly receives or retains it. A timely, good-faith investigation for related overpayments from the same or a similar cause can suspend the deadline until the investigation and aggregate calculation finish or 180 days after the initial identification, whichever is earlier, but this practice isn't investigating. Keeping an overpayment past the deadline can create False Claims Act liability.

Source: 42 CFR 401.305 (reporting and returning overpayments), Paragraphs (a)(2), (b)(1), (b)(3) and (e)

Reimbursement and collections (Questions 21–27)

Question 21 · CPB-21 · Reimbursement and collections

A collection agency hired by a practice phones patients about unpaid balances. With no other information about a patient's schedule, which calling window is presumed convenient under the Fair Debt Collection Practices Act (FDCPA)?

A. 8 a.m. to 9 p.m. in the agency's time zone
B. 9 a.m. to 5 p.m. on weekdays only
C. 8 a.m. to 9 p.m. in the patient's local time
D. Any time, as long as the agency leaves a voicemail

Show answer and explanation

Answer: C. 8 a.m. to 9 p.m. in the patient's local time

The FDCPA presumes calls are inconvenient before 8 a.m. or after 9 p.m. at the consumer's location. A collector who knows another time is inconvenient must avoid it too. Contact outside the window needs the consumer's consent or court permission. A voicemail doesn't change the rule.

Source: 15 U.S.C. 1692a and 1692c (FDCPA), Section 1692c(a)(1); CFPB Regulation F: Communications in debt collection, 12 CFR 1006.6(b)(1)(i) and (b)(4)

Question 22 · CPB-22 · Reimbursement and collections

Lakeview Family Medicine's own billing staff call patients about balances owed to Lakeview, using Lakeview's name. Are they "debt collectors" under the FDCPA?

A. Yes. Anyone collecting a medical debt is covered
B. Generally no. The FDCPA definition targets third parties collecting debts owed to someone else
C. Yes, but only for balances over 90 days old
D. No, because medical debt is exempt from the FDCPA

Show answer and explanation

Answer: B. Generally no. The FDCPA definition targets third parties collecting debts owed to someone else

The FDCPA's definition of "debt collector" covers people who collect debts owed to another. A creditor's own employees collecting the creditor's debts in its name are generally outside that definition. The answer changes if the creditor uses a different name that suggests a third party is collecting. Medical debt isn't exempt, and account age isn't part of the definition.

Source: 15 U.S.C. 1692a and 1692c (FDCPA), Section 1692a(6); CFPB Regulation F: Definitions, 12 CFR 1006.2(i)(1) and (i)(2)(i)

Question 23 · CPB-23 · Reimbursement and collections

A patient with a $450 balance from last spring files for bankruptcy. The practice receives notice that an automatic stay is in effect for this pre-filing debt. What should the practice do about that balance?

A. Stop collection activity on it; the bankruptcy automatic stay applies
B. Send it to a collection agency right away
C. Add interest so the claim in bankruptcy is larger
D. Call the patient to set up a payment plan

Show answer and explanation

Answer: A. Stop collection activity on it; the bankruptcy automatic stay applies

The automatic stay in this case stops acts to collect a debt that arose before the filing. The practice should stop collection activity and follow its bankruptcy procedures. Collection demands or a referral aimed at collecting this stayed balance would conflict with the stay.

Source: 11 U.S.C. 362 (automatic stay), Subsection (a)(6); U.S. Courts: Chapter 7 Bankruptcy Basics, How Chapter 7 Works: automatic stay and collection actions while it is in effect

Question 24 · CPB-24 · Reimbursement and collections

A remittance line shows the adjustment PR-2. What does it mean?

A. Contractual adjustment for the provider to write off
B. Deductible owed by the patient
C. Payer-initiated reduction
D. Patient responsibility for coinsurance

Show answer and explanation

Answer: D. Patient responsibility for coinsurance

The group code tells you who's responsible; the reason code tells you why. PR means patient responsibility. Reason code 2 is the coinsurance amount. A contractual write-off uses group code CO. Reason code 1, not 2, is the deductible. Payer-initiated reductions use group code PI.

Source: X12: Claim Adjustment Group Codes, CO, PR, OA, PI; X12: Claim Adjustment Reason Codes, Codes 1, 2, 3 and 45

Question 25 · CPB-25 · Reimbursement and collections

A remittance shows reason code 45 on a line. What does it describe?

A. The patient's deductible
B. A duplicate claim
C. The charge is more than the fee schedule or contracted amount
D. The claim was filed late

Show answer and explanation

Answer: C. The charge is more than the fee schedule or contracted amount

Reason code 45 means the charge exceeds the fee schedule, maximum allowable or contracted amount. The accompanying group code identifies liability: X12 permits code 45 with CO or PR. CO marks a contractual obligation; code 45 alone does not establish a patient balance. The deductible is reason code 1.

Source: X12: Claim Adjustment Reason Codes, Codes 1, 2, 3 and 45; X12: Claim Adjustment Group Codes, CO and PR

Question 26 · CPB-26 · Reimbursement and collections

How does Medicare calculate the base Physician Fee Schedule amount for a service, before claim-level adjustments?

A. (Work RVU × work GPCI + practice expense RVU × PE GPCI + malpractice RVU × MP GPCI) × conversion factor
B. Billed charge × conversion factor
C. Total RVUs, with no other adjustment
D. Billed charge × geographic adjustment

Show answer and explanation

Answer: A. (Work RVU × work GPCI + practice expense RVU × PE GPCI + malpractice RVU × MP GPCI) × conversion factor

The fee schedule is built from relative value units (RVUs) for physician work, practice expense and malpractice. Each RVU is multiplied by its geographic practice cost index (GPCI), the three results are added, and the sum is multiplied by the conversion factor. The provider's billed charge isn't part of the formula.

Source: Medicare Claims Processing Manual, Chapter 12, Section 20.1.A

Question 27 · CPB-27 · Reimbursement and collections

A commercial plan approved prior authorization for a patient's procedure. Before the visit, the patient asks the front desk whether that approval guarantees the plan will pay. What's the accurate answer?

A. Yes. Prior authorization is a payment guarantee
B. Yes, as long as the procedure happens within the year
C. No, but the practice must then write off any unpaid amount
D. No. Authorization isn't a promise to pay; eligibility and benefit terms still apply

Show answer and explanation

Answer: D. No. Authorization isn't a promise to pay; eligibility and benefit terms still apply

Prior authorization means the plan decided the service is medically necessary. It isn't a promise to cover the cost. The claim still depends on things like the patient's eligibility and benefits on the date of service. Whether an unpaid amount is the patient's or the practice's depends on why the claim wasn't paid, so an automatic write-off isn't the rule.

Source: HealthCare.gov: Preauthorization, Definition

Claims and billing (Questions 28–34)

Question 28 · CPB-28 · Claims and billing

An Original Medicare Part B service was provided on March 4, 2026. No exception applies. What is the deadline to file the claim?

A. 90 days after the date of service
B. One calendar year after the date of service (March 4, 2027)
C. Six months after the date of service
D. 18 months after the date of service

Show answer and explanation

Answer: B. One calendar year after the date of service (March 4, 2027)

Medicare claims must be filed within one calendar year after the date of service. A deadline that falls on a weekend or federal holiday moves to the next workday. Exceptions exist (for example, retroactive entitlement or contractor error), but none applies here. The other time frames don't apply to Medicare.

Source: 42 CFR 424.44 (time limits for filing claims), Paragraph (a)(1); exceptions in (b); federal-nonworkday extension in (c)

Question 29 · CPB-29 · Claims and billing

An Original Medicare beneficiary wants to request a redetermination but doesn't use the CMS form. What must the written request include?

A. Beneficiary name, Medicare number, the items or services and dates of service in question, and the name of the party or representative, plus an explanation of why the determination is disputed
B. The provider's tax ID and complete medical records
C. A physician's signature and a new order
D. Only a copy of the Medicare Summary Notice

Show answer and explanation

Answer: A. Beneficiary name, Medicare number, the items or services and dates of service in question, and the name of the party or representative, plus an explanation of why the determination is disputed

CMS allows a redetermination request on form CMS-20027 or as a written request. The written request identifies the beneficiary, Medicare number, disputed items or services and dates, the requesting party or representative, and why the appellant disagrees. Include supporting documentation and send it to the Medicare Administrative Contractor that made the initial determination. A provider tax ID, physician signature or unannotated notice alone does not supply those details.

Source: CMS: First Level of Appeal — Redetermination, Requesting a Redetermination: written-request information and supporting documentation

Question 30 · CPB-30 · Claims and billing

A claim comes back rejected before processing: the member ID on the claim, HBR48261, doesn't match the payer's records. The eligibility check done at intake shows member ID HBR48216, active on the date of service. All other fields match. What should the biller do?

A. File an appeal of the rejection
B. Transfer the balance to the patient
C. Correct the member ID to HBR48216 from the verified record and resubmit
D. Wait 30 days and check status again

Show answer and explanation

Answer: C. Correct the member ID to HBR48216 from the verified record and resubmit

The last two digits were transposed. This front-end rejection requires correction and resubmission; the claim hasn't been adjudicated, so there's no coverage decision to appeal. Fix the ID from the verified eligibility response, document the correction and resubmit. The patient shouldn't be billed for the practice's data-entry error, and waiting won't fix a rejected claim.

Source: CMS: Electronic Health Care Claims, How Electronic Claims Submission Works

Question 31 · CPB-31 · Claims and billing

The rendering provider and billing provider have different NPIs. On the CMS-1500 claim form, where do those NPIs go?

A. Rendering in Item 33a; billing in Item 24J
B. Rendering in Item 24J; billing in Item 33a
C. Both in Item 17b
D. Rendering in Item 32a; billing in Item 33a

Show answer and explanation

Answer: B. Rendering in Item 24J; billing in Item 33a

The rendering provider's NPI goes in the unshaded area of Item 24J. Item 33a holds the billing provider's NPI. Under NUCC's general instructions, the rendering identifier is reported in 24J when it differs from the billing information. Item 17b is the referring, ordering or supervising provider's NPI. Item 32a is the NPI of the service facility location.

Source: NUCC 1500 Claim Form Reference Instruction Manual, v13.0 (July 2025), Item 24J, p. 44; Item 33a, p. 55; Item 17b, p. 27; Item 32a, p. 53

Question 32 · CPB-32 · Claims and billing

What goes in Item 24E (diagnosis pointer) on the CMS-1500?

A. The full ICD-10-CM codes for that line
B. The place-of-service code
C. Modifiers for the procedure
D. Letters (A–L) that point to the diagnoses listed in Item 21

Show answer and explanation

Answer: D. Letters (A–L) that point to the diagnoses listed in Item 21

Item 21 lists up to 12 diagnosis codes, labeled A through L. Item 24E links each service line to the relevant diagnoses by entering those letters, not the codes themselves. The field holds up to 4 characters with no commas. Place of service goes in 24B and modifiers in 24D.

Source: NUCC 1500 Claim Form Reference Instruction Manual, v13.0 (July 2025), Item 21, p. 32; Item 24E, p. 39

Question 33 · CPB-33 · Claims and billing

A patient signs to authorize her insurer to pay benefits directly to the provider. Which CMS-1500 item records that authorization?

A. Item 13
B. Item 12
C. Item 31
D. Item 17

Show answer and explanation

Answer: A. Item 13

Item 13 is the insured's signature authorizing payment of medical benefits to the provider (assignment of benefits). Item 12 is the patient's authorization to release information needed to process the claim. Item 31 is the physician or supplier signature. Item 17 is the referring, ordering or supervising provider's name.

Source: NUCC 1500 Claim Form Reference Instruction Manual, v13.0 (July 2025), Items 12 and 13, p. 22

Question 34 · CPB-34 · Claims and billing

A hospital outpatient department needs to bill its facility charges on paper under a valid exception to electronic filing. Which form does it use?

A. CMS-1500
B. CMS-R-131
C. CMS-1450 (UB-04)
D. CMS-20027

Show answer and explanation

Answer: C. CMS-1450 (UB-04)

Institutional providers use the CMS-1450, commonly called the UB-04. The CMS-1500 is for non-institutional providers and suppliers, such as physicians billing professional services. CMS-R-131 is the Advance Beneficiary Notice of Noncoverage (ABN) form, and CMS-20027 is the redetermination request form. Most Medicare claims must be filed electronically; paper is the exception.

Source: CMS: CMS-1450 (UB-04), Page body; CMS: CMS-1500, Page body

Coding (Questions 35–38)

Question 35 · CPB-35 · Coding

An outpatient visit note says: "cough and fever, rule out pneumonia." No definitive diagnosis is made by the end of the visit. What should be reported?

A. Pneumonia
B. Codes for the cough and fever
C. Pneumonia plus codes for the cough and fever
D. Nothing until test results come back

Show answer and explanation

Answer: B. Codes for the cough and fever

For outpatient services, the ICD-10-CM guidelines say each encounter is coded to the level of certainty known at that encounter. When a definitive diagnosis hasn't been established by the end of the visit, report the signs and symptoms. Coding pneumonia would report a condition that was only being ruled out.

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, Section IV.H, Uncertain diagnosis, p. 114; Section IV.D, p. 113; ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, Section IV.H, Uncertain diagnosis, p. 114; Section IV.D, p. 113

Question 36 · CPB-36 · Coding

A radiologist reads and interprets an X-ray that was taken on hospital equipment by hospital staff. The X-ray code has separate professional and technical components. Which modifier does the radiologist add to bill only the interpretation?

A. 26
B. TC
C. No modifier; bill the global service
D. 25

Show answer and explanation

Answer: A. 26

Modifier 26 is the professional component: the physician's interpretation and report. TC is the technical component: equipment, supplies and staff, which the hospital provided here. Billing with no modifier claims the global service, both components. Modifier 25 is for a separately identifiable E/M service.

Source: Noridian JE Part B: Modifier 26, Professional component

Question 37 · CPB-37 · Coding

A physician performs a minor procedure and, on the same day, provides a significant, separately identifiable E/M service for a different problem. Which modifier goes on the E/M code?

A. 59
B. 57
C. 24
D. 25

Show answer and explanation

Answer: D. 25

Modifier 25 identifies a significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day as a procedure or other service. Modifier 59 is for distinct procedural services, not E/M. Modifier 57 marks an E/M that resulted in the decision for major surgery. Modifier 24 is for an unrelated E/M during a post-op period.

Source: CMS NCCI Policy Manual for Medicare Services, Chapter I (2026), Section D, pp. I-12–I-13; Section E(b), pp. I-15–I-16

Question 38 · CPB-38 · Coding

Which code set identifies products, supplies and services not in CPT, such as ambulance services and durable medical equipment?

A. CPT Category I
B. ICD-10-CM
C. HCPCS Level II
D. ICD-10-PCS

Show answer and explanation

Answer: C. HCPCS Level II

HCPCS Level II is used mainly to identify products, supplies and services that CPT doesn't include, such as ambulance services and durable medical equipment, prosthetics, orthotics and supplies used outside a physician's office. ICD-10-CM codes diagnoses. ICD-10-PCS codes inpatient hospital procedures. CPT Category I codes procedures and services.

Source: CMS: HCPCS — General information, HCPCS Level II; CMS: Health Care Code Sets (MLN900943), September 2026, pp. 3–4: ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II

Case analysis (Questions 39–50)

Document A — Northgate Health Plan: Outpatient Imaging Prior Authorization Policy

Fictional practice document. Names, amounts and plan terms exist only for this exercise.

This policy applies to contracted Northgate providers. Business days are Monday through Friday, excluding holidays.

Outpatient MRI and CT scans require prior authorization before the service.
An approved authorization remains valid through the 60th calendar day after the approval date; the approval date is day 0.
Urgent exception: when a service is urgent, the provider must notify Northgate within 2 business days after the service.
Claims for services without a valid authorization are denied as provider liability. Contracted providers may not bill the member for these services.

Question 39 · CPB-39 · Case analysis

Use Document A. Northgate approved prior authorization for a routine outpatient MRI on March 3, 2026. The MRI is performed on May 10, 2026. What happens to the claim?

A. It's paid, because an authorization was approved
B. It's denied because the authorization expired on May 2, and the practice can't bill the member
C. It's paid, but the member owes the full amount
D. It pends until the provider sends records

Show answer and explanation

Answer: B. It's denied because the authorization expired on May 2, and the practice can't bill the member

The authorization is valid for 60 calendar days from approval. Counting from March 3: 28 days to March 31, 30 more to April 30, then 2 more lands on May 2. The May 10 MRI was performed without a valid authorization. Under item 4 of the policy, the claim is denied as provider liability, and a contracted provider can't bill the member.

Source: Fictional Document A, Items 2 and 4; approval-date counting convention

Question 40 · CPB-40 · Case analysis

Use Document A. A patient needs an urgent MRI on a Friday. The office notifies Northgate the following Tuesday. There are no holidays that week. Did the office meet the policy?

A. Yes. Tuesday is the second business day after the service
B. No. More than 48 hours passed
C. No. Urgent services must be reported the same day
D. Only if the ordering physician makes the call

Show answer and explanation

Answer: A. Yes. Tuesday is the second business day after the service

The policy allows notice within 2 business days after an urgent service. Business days after Friday are Monday (day 1) and Tuesday (day 2), so Tuesday notice is on time. The policy counts business days, not hours, and it doesn't say who must call.

Source: Fictional Document A, Item 3; business-day definition

Question 41 · CPB-41 · Case analysis

Use Document A. Northgate denied a routine MRI for lack of authorization. The practice confirms no authorization was ever requested, and the service wasn't urgent. What's the correct handling?

A. Bill the member for the full charge
B. Resubmit the claim marked as urgent
C. Send the member's account to collections
D. Adjust the balance as provider liability and don't bill the member

Show answer and explanation

Answer: D. Adjust the balance as provider liability and don't bill the member

Item 4 says claims without a valid authorization are provider liability, and contracted providers can't bill the member. Since no authorization was requested and the urgent exception doesn't apply, the practice absorbs the balance. Relabeling the service as urgent would misrepresent it.

Source: Fictional Document A, Item 4; contracted-provider scope

Document B — Northgate Health Plan: Remittance advice excerpt

Fictional practice document. Names, amounts and plan terms exist only for this exercise.

Provider contract note: contractual obligation (CO) adjustments may not be billed to the member.

Document B remittance advice lines: billed, allowed, adjustments and paid amounts
Line	Service	Billed	Allowed	Adjustments	Paid
1	Office procedure	$240.00	$180.00	CO-45 $60.00 · PR-1 $100.00 · PR-2 $16.00	$64.00
2	Office visit	$95.00	$70.00	CO-45 $25.00 · PR-3 $20.00	$50.00

Adjustment key: CO = contractual obligation; PR = patient responsibility; reason 1 = deductible; reason 2 = coinsurance; reason 3 = copayment; reason 45 = charge exceeds the fee schedule or contracted amount.

Question 42 · CPB-42 · Case analysis

Use Document B. What total is labeled patient responsibility on this remittance for the two lines?

A. $85.00
B. $114.00
C. $136.00
D. $221.00

Show answer and explanation

Answer: C. $136.00

Add every PR adjustment: $100.00 (PR-1, deductible) + $16.00 (PR-2, coinsurance) + $20.00 (PR-3, copay) = $136.00. $85 is the total CO write-off. $114 is what the plan paid. $221 wrongly adds the CO amounts, which the contract says can't be billed to the member.

Source: Fictional Document B, Remittance lines 1–2 and provider contract note; X12: Claim Adjustment Group Codes, CO, PR, OA, PI; X12: Claim Adjustment Reason Codes, Codes 1, 2, 3 and 45

Question 43 · CPB-43 · Case analysis

Use Document B. What is the total contractual adjustment the practice writes off?

A. $85.00
B. $136.00
C. $221.00
D. $0.00

Show answer and explanation

Answer: A. $85.00

The CO-45 adjustments are $60.00 + $25.00 = $85.00. That's the difference between billed charges and allowed amounts: ($240 − $180) + ($95 − $70) = $85. The contract note says CO amounts can't be billed to the member, so they're written off. $136 is patient responsibility.

Source: Fictional Document B, Remittance lines 1–2 and provider contract note; X12: Claim Adjustment Group Codes, CO, PR, OA, PI; X12: Claim Adjustment Reason Codes, Codes 1, 2, 3 and 45

Question 44 · CPB-44 · Case analysis

Use Document B. What total payer payment should be posted for this claim?

A. $250.00
B. $114.00
C. $136.00
D. $335.00

Show answer and explanation

Answer: B. $114.00

Post what the plan actually paid: $64.00 + $50.00 = $114.00. Each line balances: line 1, $100 + $16 + $64 = $180 allowed; line 2, $20 + $50 = $70 allowed. $250 is the total allowed amount, $335 is total billed, and $136 is the patient's share.

Source: Fictional Document B, Remittance lines 1–2 and provider contract note; X12: Claim Adjustment Reason Codes, Codes 1, 2, 3 and 45

Document C — Lakeview Family Medicine: Aged A/R report excerpt (run date October 21, 2026)

Fictional practice report. Names, balances and commercial-plan terms are invented; the cited Original Medicare filing rule is real.

Payer filing limits printed on the report: Original Medicare fee-for-service — 1 calendar year from the date of service · Plan X — 90 days from the date of service · Plan Y — 180 days from the date of service.

For this exercise, no Medicare filing extension applies. Plan Y requires initial and corrected claims within 180 calendar days after the service, excluding the service date from the count; no earlier appeal deadline applies to account 1003.

Practice financial policy printed on the report: Patient balances with 3 statements sent and no payment or payment arrangement are reviewed for collection-agency referral. Never refer accounts on an active payment plan or in bankruptcy.

Document C aged A/R accounts: responsible party, date of service, status and balance
Account	Responsible party	Date of service	Status	Balance
1001	Original Medicare	11/03/2025	No claim on file at payer	$310
1002	Patient (after Plan X paid)	05/10/2026	3 statements sent; no payment; no arrangement	$145
1003	Plan Y	08/01/2026	Denied for missing information; corrected claim not yet sent	$520
1004	Patient	03/15/2026	Active payment plan, payments current	$600

Aging totals for the whole practice:

Document C aging totals for the whole practice by age bucket
0–30 days	31–60 days	61–90 days	91–120 days	Over 120 days	Total
$42,000	$18,000	$12,000	$9,000	$9,000	$90,000

Question 45 · CPB-45 · Case analysis

Use Document C. Which account should be worked first to avoid losing the right to payment?

A. Account 1003, because it has the largest balance
B. Account 1004, because it's the patient's largest balance
C. Account 1002, because three statements have gone out
D. Account 1001, because its Medicare filing deadline is November 3, 2026

Show answer and explanation

Answer: D. Account 1001, because its Medicare filing deadline is November 3, 2026

Account 1001 has no claim on file at the payer, and Original Medicare's filing limit is one calendar year from the November 3, 2025 date of service. That's November 3, 2026, just 13 days after the report date. Account 1003's 180-day limit runs from August 1, 2026 to January 28, 2027. A large balance doesn't help if the claim can no longer be filed.

Source: Fictional Document C, Account 1001; filing and corrected-claim rules; 42 CFR 424.44 (time limits for filing claims), Paragraph (a)(1); exceptions in (b); federal-nonworkday extension in (c)

Question 46 · CPB-46 · Case analysis

Use Document C. What percentage of the practice's total A/R is more than 90 days old?

A. 10%
B. 33%
C. 20%
D. 47%

Show answer and explanation

Answer: C. 20%

Balances over 90 days are $9,000 (91–120) + $9,000 (over 120) = $18,000. $18,000 ÷ $90,000 = 0.20, or 20%. 10% counts only one of the two buckets. About 33% (rounded) also adds the 61–90 bucket, which isn't over 90 days. About 47% (rounded) is the 0–30 bucket's share.

Source: Fictional Document C, Aging totals; worked calculation from the supplied amounts

Question 47 · CPB-47 · Case analysis

Use Document C. Which account meets the printed financial policy for collection-agency referral review?

A. Account 1004
B. Account 1002
C. Account 1001
D. Account 1003

Show answer and explanation

Answer: B. Account 1002

Account 1002 is a patient balance with three statements sent and no payment or arrangement, which is exactly what the policy describes. Account 1004 is on an active payment plan, which the policy excludes. Accounts 1001 and 1003 are insurance claims that still need to be filed or corrected, not patient balances.

Source: Fictional Document C, Practice financial policy and account statuses

Document D — Ridgeway Diagnostics: Coverage policy for "Test Q"

Fictional practice document. Names, amounts and plan terms exist only for this exercise.

This is a practice policy written for this exercise. It is modeled on the structure of a coverage determination; Test Q is not a real test. For Questions 48–50, apply this fictional policy to an otherwise covered Original Medicare Part B laboratory test.

Covered: monitoring of an established chronic condition listed in this policy, or evaluation of new symptoms.
Frequency limit: once every 12 months for stable monitoring.
Not covered: screening with no symptoms and no listed condition.

Question 48 · CPB-48 · Case analysis

Use Document D. A patient with Original Medicare has a listed chronic condition and had Test Q seven months ago. The physician orders it again for routine monitoring; nothing has changed. Is the repeat test covered under the policy?

A. No. Stable monitoring is limited to once every 12 months
B. Yes, because the condition is on the covered list
C. Yes, if modifier 59 is added
D. Only if it's billed under a different diagnosis

Show answer and explanation

Answer: A. No. Stable monitoring is limited to once every 12 months

The condition is covered, but the frequency limit allows stable monitoring only once every 12 months, and the last test was seven months ago. Adding modifier 59 doesn't change this policy's 12-month frequency limit. Changing the diagnosis to get paid would misrepresent the service.

Source: Fictional Document D, Covered services and 12-month stable-monitoring frequency limit

Question 49 · CPB-49 · Case analysis

Use Document D. For the repeat test in Question 48, what should the office do before drawing the specimen?

A. Draw the specimen and bill the patient if Medicare denies
B. Get the patient's verbal agreement
C. Issue a valid ABN and, if the patient chooses the test and Medicare claim submission, report modifier GZ
D. Issue a valid ABN and, if the patient chooses the test and Medicare claim submission, report modifier GA

Show answer and explanation

Answer: D. Issue a valid ABN and, if the patient chooses the test and Medicare claim submission, report modifier GA

When the provider expects Original Medicare to deny an otherwise covered service as not reasonable and necessary, a valid ABN must be given before the service to transfer potential financial liability and let the patient decide whether to proceed. If the patient selects Option 1, signs the valid notice and receives the test, submit the claim with modifier GA and keep the ABN on file. GZ is for an expected medical-necessity denial when no ABN was issued. A signature alone does not make a notice valid; the form must be properly completed and explained. Without a proper ABN, the practice generally can't shift this denied service's cost to the patient.

Source: Fictional Document D, The frequency-denial scenario in Question 48; CMS MLN booklet: Medicare Advance Written Notices of Non-coverage (MLN006266), When to issue, pp. 5–6; Table 2 modifiers, p. 11; CMS: Advance Beneficiary Notice of Non-coverage Tutorial, April 2026: Requirements; Options 1–3; Signature

Question 50 · CPB-50 · Case analysis

Use Document D. Original Medicare denied the repeat test. The patient's Medicare Summary Notice is dated June 3, 2026, and there's no evidence of when she actually received it. By what date must the Medicare Administrative Contractor (MAC) receive her redetermination request under the ordinary 120-day filing period?

A. October 1, 2026
B. December 3, 2026
C. October 6, 2026
D. September 1, 2026

Show answer and explanation

Answer: C. October 6, 2026

A redetermination must be requested within 120 days of receiving the initial determination. Unless there's evidence otherwise, receipt is presumed to be 5 days after the notice date: June 3 + 5 = June 8. Then 120 days from June 8: 22 days to June 30, 31 in July (53), 31 in August (84), 30 in September (114), and 6 more lands on October 6, 2026. October 1 counts from the notice date and skips the 5-day presumption. The request is filed when the contractor receives it.

Source: 42 CFR 405.942 (time frame for redetermination), Paragraph (a), including (a)(1)–(2)

Your score and what to review

Count your correct answers in each section. Your result describes these 50 practice questions only. It isn't an AAPC score and doesn't predict whether you'll pass. With 3 or 4 questions in some sections, one miss swings the percentage a lot, so treat small sections as a pointer, not a verdict.

Practice set sections with question ranges and what to review after a miss
Section	Questions	If you missed some, review
Types of insurance	1–11 (11)	Payer order: Medicare Secondary Payer rules, the birthday rule, Medicaid and TRICARE ordering. Medicare cost sharing math and the limiting charge.
Billing regulations	12–17 (6)	NCCI edits and modifier indicators, MUEs, incident-to supervision, global surgery periods, Stark, Anti-Kickback and the False Claims Act.
HIPAA and compliance	18–20 (3)	Minimum necessary and its exceptions, patient access deadlines, the 60-day overpayment rule.
Reimbursement and collections	21–27 (7)	FDCPA basics, the bankruptcy automatic stay, remittance group and reason codes, the fee schedule formula, prior authorization limits.
Claims and billing	28–34 (7)	Medicare timely filing, redetermination requests, rejections versus denials, key CMS-1500 items, CMS-1500 versus CMS-1450.
Coding	35–38 (4)	Coding signs and symptoms when there's no definitive diagnosis, modifiers 25 and 26, what HCPCS Level II covers.
Case analysis	39–50 (12)	Reading a policy and applying it exactly: date math, remittance math, aging reports and coverage limits.

Keep a short review log

For every question you missed or guessed, write one line. The goal is to name the rule, not just the right letter.

Review log template with one example row
Question	Missed or guessed?	What tripped me up	The rule or math	What I'll check next
8	Missed	Took 20% of the full $300	Deductible first ($100), then 20% of the rest ($40) = $140	Re-read Medicare's cost-sharing page, then redo Questions 8 and 42

Then explain each rule out loud without looking, and retry those questions a few days later. Getting the same questions right a second time shows you've learned these items. It doesn't prove exam readiness by itself, so keep practicing on new material.

How the real CPB exam works

How the real CPB exam works: what AAPC says for each exam detail
Exam detail	What AAPC says
Format	135 multiple-choice questions in one sitting
Time	4 hours (about 1.8 minutes per question on average)
Passing	70% overall, which means at least 95 correct
Where	Online with a live remote proctor, or on a computer at a testing center
Books allowed	AMA's CPT Professional Edition, plus ICD-10-CM and HCPCS Level II from any publisher
Book years	Current-year or prior-year print books, one copy of each. AAPC's eBook option on the exam platform is the current year. AAPC's general policy uses the current calendar year's code sets and January updates; follow any exam-date-specific transition notice.
Published voucher prices	AAPC's CPB exam page and main cost FAQ list $425 for one attempt or $499 for two; see the official-source difference below

Sources: AAPC: CPB certification · AAPC: Taking the CPB exam · AAPC: What years' books should I use? · AAPC Examinee Instructions (PDF) · AAPC: How much does the exam cost?

Price check: AAPC's CPB exam page and main cost FAQ list $425 for one attempt and $499 for two. Its Help Center pricing article lists $399 and $499. Confirm the amount shown for your purchase before paying; these are voucher prices, and membership is separate.

The real exam's seven sections

AAPC CPB domains: real exam question counts compared with this practice set
AAPC domain	Real exam	This practice set
Types of insurance	29	11
Billing regulations	17	6
HIPAA and compliance	7	3
Reimbursement and collections	19	7
Claims and billing	19	7
Coding	10	4
Case analysis	34	12
Total	135	50

We allocated 50 questions across AAPC's seven domains to keep the mix broadly similar; it doesn't make this set a miniature version of the exam, and it doesn't tell you how long to study each topic.

On pacing: the case analysis questions on the real exam come with documents to read, like the four in this set. Bank time on the quicker recall questions so you aren't rushing the cases at the end.

What this set doesn't cover: it touches every domain but not every topic, and none of the questions require looking up codes. On the real exam you'll use your code books, so practice finding codes and reading guidelines in them as a separate drill.

Questions people ask

Is the CPB exam open book?

Yes, for code books. You can use AMA's CPT Professional Edition and your choice of ICD-10-CM and HCPCS Level II books. Only the approved references are allowed; a separate study guide or legal reference is not on AAPC's CPB list.

How many questions can I miss and still pass?

AAPC requires at least 95 correct out of 135. That means you can miss up to 40.

Are these the same as real exam questions?

No. We wrote every question here, and none comes from an AAPC exam. They follow AAPC's published topics and use scenarios, including document-based cases.

Should I take the CPB or the CPC?

They're separate exams for different jobs. The CPB tests billing and the revenue cycle across 135 questions. The CPC tests coding across 100 questions. Our medical billing and coding certification guide compares them, and there's a free CPC practice test if coding is your target.

Is this the bookkeeping CPB?

No. This page covers AAPC's Certified Professional Biller, a medical billing credential. Some bookkeeping credentials use the same initials, including the Certified Professional Bookkeeper designation in Canada.

What does it cost, and what if I don't pass?

AAPC's CPB page and main cost FAQ list $425 for one attempt or $499 for two; its Help Center differs on the single-attempt price, as noted above. Our AAPC exam registration guide walks through scheduling, and the AAPC retake policy page covers a second attempt.

Next steps

AAPC exam registration: booking, remote versus testing center
AAPC exam results: what happens after test day
AAPC certification renewal: CEUs and membership once you pass
Free CBCS practice test: if you're weighing NHA's billing and coding credential instead

Sources and how we checked

Last verified: October 21, 2026. We checked the exam facts on this page (format, time, passing requirement, domain counts, allowed books and price) against AAPC's own pages. We checked every answer against the source linked beside it: CMS manuals and guidance, the Code of Federal Regulations and U.S. Code, HHS, HHS-OIG, Medicare.gov, Medicaid.gov, TRICARE, HealthCare.gov, X12, the National Uniform Claim Committee and the CDC's ICD-10-CM guidelines. Patient names, practice names, example amounts and the Northgate, Lakeview and Ridgeway case documents are fictional; the cited government programs and billing rules are real.

Written by the Castleport Test Prep Editorial Team. We used AI-assisted tools for drafting and editing. Our verification was a source check, not a review by a certified biller. See our editorial standards.

Exam and fee sources: AAPC: CPB certification · AAPC: Taking the CPB exam · AAPC: Exam cost · AAPC: Book years · AAPC Examinee Instructions

Billing rule sources: CMS Medicare Secondary Payer Manual, Ch. 1 · NCCI Policy Manual, Ch. I (2026) · CMS Global Surgery booklet · CMS ABN booklet · Medicare Claims Processing Manual, Ch. 12 · 42 CFR 424.44 · 42 CFR 405.942 · 42 CFR 405.944 · 42 CFR 410.26 · 45 CFR 164.502 · 45 CFR 164.524 · HHS-OIG: Fraud & Abuse Laws · NUCC 1500 Instruction Manual · X12 group codes · X12 reason codes · ICD-10-CM Guidelines FY 2026 · ICD-10-CM Guidelines FY 2027

Castleport Test Prep is an independent exam prep publisher. We're not affiliated with, endorsed by, or approved by AAPC. CPB, CPC and other credential names are used to identify their subjects, and trademarks belong to their respective owners; CPT is a trademark of the American Medical Association. These questions are original and unofficial, not actual exam questions, and working through them doesn't award certification or guarantee any result.