Castleport Test Prep

Free CPMA Practice Test: 50 Questions With Answers

This free CPMA practice test has 50 original, unofficial questions for AAPC's Certified Professional Medical Auditor exam, including 18 questions on seven audit records. Pick an answer, then open the explanation; your score describes this set only, not your CPMA result.

Question 1 · CPMA-P01 · AI scribes and signatures

A physician uses an AI scribe tool to draft a Medicare office-visit note, then reviews, signs and dates the entry. During your audit, you notice the note has no signature or identifier from the scribe. What's the right finding on that point?

  • A. Defect; every scribe, human or AI, must also sign and date the entry.
  • B. Defect; Medicare won't accept a note drafted with an AI scribe tool.
  • C. No defect; the physician's signature authenticates the entry.
  • D. No defect, but only once the office manager countersigns the note too.
Show answer and explanation

C. CMS says it doesn't require the scribe to sign or date the documentation, and that applies to AI scribes too. The provider signs the entry to authenticate it. A adds a requirement CMS doesn't impose. B invents a ban. D adds a signature Medicare doesn't require for this purpose. This finding settles authentication only; the note still has to support what was billed.

Source: CMS MLN905364, Complying with Medicare Signature Requirements (July 2025), p. 2.

Jump to: Questions 2–32 · Audit cases, Questions 33–50 · Score your practice test

CPMA practice questions

Medical record standards and documentation guidelines

Question 2 · CPMA-P02 · Psychotherapy notes

A payer asks a behavioral health practice, a HIPAA covered entity, for records supporting a psychotherapy claim. The psychologist keeps private notes about session conversations in a separate file. The chart also holds session start and stop times, medication monitoring, and a treatment-plan summary. Which item generally needs the patient's written authorization before it's disclosed?

  • A. Everything listed, because it's all mental health information
  • B. The separately kept notes about session conversations
  • C. Only the session start and stop times
  • D. Nothing, because disclosures for payment never need authorization
Show answer and explanation

B. Psychotherapy notes are a mental health professional's notes on counseling conversations that are kept separate from the rest of the record. HIPAA requires authorization for most uses and disclosures of them, and the ordinary payment permission doesn't authorize this disclosure to the payer. The definition specifically excludes session times, medication monitoring, and summaries of the treatment plan, so those stay in the ordinary record. That's why A and C are wrong. D misses the psychotherapy-notes exception.

Source: 45 CFR 164.501, definitions of psychotherapy notes and health care operations; 45 CFR 164.508(a)(2), authorization for psychotherapy notes; 45 CFR 164.506(a) and (c)(1), treatment, payment and health care operations.

Question 3 · CPMA-P03 · Breach notification timing

On September 3, 2026, a HIPAA-covered practice discovers that an unencrypted laptop holding patients' protected health information (PHI) was stolen. The incident is a reportable breach, and law enforcement hasn't asked for a delay. Under the HIPAA Breach Notification Rule, what's the outer limit for notifying the affected patients?

  • A. Within 30 calendar days after discovery, with no exceptions allowed
  • B. Within 60 business days after the internal investigation is complete
  • C. By December 31 of the calendar year in which the breach happened
  • D. Without unreasonable delay; at most 60 calendar days after discovery
Show answer and explanation

D. The Breach Notification Rule requires notice without unreasonable delay and in no case later than 60 calendar days after discovery. Sixty days is a ceiling, not a target. A is stricter than the federal rule (a state law might be). B counts business days and starts the clock at the wrong point. C has no basis. The rule has a separate exception for a delay requested by law enforcement, which doesn't apply here.

Source: 45 CFR 164.404(b), timing of breach notice to individuals; 45 CFR 164.412, law-enforcement delay.

Question 4 · CPMA-P04 · PHI use for internal audits

A HIPAA-covered practice's compliance team reviews a sample of charts to check coding accuracy. The charts don't include psychotherapy notes. Under HIPAA, does the practice need each patient's authorization for this internal review?

  • A. Yes; every patient whose chart is sampled must sign an authorization first.
  • B. Only for Medicare patients' charts, because CMS owns those medical records outright.
  • C. No, but only after every sampled chart has been fully de-identified.
  • D. No; internal auditing is a health care operation, so no authorization is needed.
Show answer and explanation

D. HIPAA defines health care operations to include conducting or arranging for medical review, legal services, and auditing functions, including fraud and abuse detection and compliance programs. A covered entity may use PHI for its own operations without authorization. A ignores that permission. B has no basis. C adds a step HIPAA doesn't require for internal operations. Access should still be limited to what the review needs.

Source: 45 CFR 164.501, definitions of psychotherapy notes and health care operations; 45 CFR 164.506(a) and (c)(1), treatment, payment and health care operations; 45 CFR 164.502(b), minimum necessary.

Question 5 · CPMA-P05 · Business associates

A HIPAA-covered practice hires an outside billing company that will receive claims data containing PHI. What must be in place before the practice shares that PHI?

  • A. A written business associate contract meeting HIPAA's requirements
  • B. Nothing, because sharing claims data for billing is a payment activity
  • C. A signed authorization from every patient whose claims are sent
  • D. A certificate stating the company is HIPAA compliant
Show answer and explanation

A. A company that handles PHI for a covered entity's billing is a business associate. Before disclosing PHI to it, the practice must get satisfactory assurances, documented in a written contract or agreement that meets 45 CFR 164.504(e). B confuses the purpose of the disclosure with the vendor relationship. C isn't required for this payment-related work. D isn't a substitute for the contract HIPAA requires.

Source: 45 CFR 160.103, definition of business associate; 45 CFR 164.502(e), disclosures to business associates; 45 CFR 164.504(e)(1)–(2), business-associate contracts.

Question 6 · CPMA-P06 · ABN timing

An Original Medicare patient is due for a lab test that the practice expects Medicare to deny because a frequency limit isn't met. The front desk hands the patient an Advance Beneficiary Notice (ABN) to sign after the specimen has been collected and the lab test has been performed. What's the finding?

  • A. Valid, because the patient signed it on the same date the test was performed
  • B. Not valid; it must be given before the service, with time to decide.
  • C. Valid, as long as modifier GA is appended to the claim line for the test
  • D. Valid, because the patient has already agreed to pay if Medicare denies it
Show answer and explanation

B. CMS requires the ABN to be given far enough in advance of a potentially noncovered service for the beneficiary to consider all available options, including not having the service. A notice handed over after the lab test was performed doesn't do that. A confuses the date with the timing. C: GA reports that a required ABN was issued; it can't fix a late one. D: agreement after the fact isn't proper advance notice.

Source: Medicare Claims Processing Manual, ch. 30, §50.8 (ABN delivery) and §40.2.2(C) (routine notices); CMS MLN006266, Medicare Advance Written Notices of Non-coverage (May 2025), pp. 8 and 11.

Question 7 · CPMA-P07 · Routine ABNs

To be safe, a clinic has every Original Medicare patient sign an ABN at check-in that covers any service they might receive that day. What's the problem?

  • A. Nothing; collecting an ABN from every patient is a recommended best practice.
  • B. Blanket ABNs aren't acceptable; each needs a real reason to expect denial.
  • C. It's acceptable, as long as the clinic has patients renew the form every year.
  • D. Nothing; Medicare requires a signed ABN from every patient at every visit.
Show answer and explanation

B. CMS says routine use of written notices isn't effective, and blanket notices for all claims or services aren't acceptable. An ABN needs a real reason to expect denial for the specific service. CMS lists limited exceptions, such as experimental items and items with frequency limits. A, C and D all treat a generic notice as valid.

Source: Medicare Claims Processing Manual, ch. 30, §50.8 (ABN delivery) and §40.2.2(C) (routine notices); CMS MLN006266, Medicare Advance Written Notices of Non-coverage (May 2025), pp. 8 and 12.

Question 8 · CPMA-P08 · Ordering diagnostic tests

A lab performs and bills a diagnostic test for an Original Medicare Part B patient on a standing schedule set by the lab. No treating physician or practitioner ordered the test, and nobody used the result to manage the patient's care. What's the audit finding?

  • A. Supported, because the result came back abnormal and needed follow-up care
  • B. Supported, because the patient personally asked the lab to run the test
  • C. Supported, because Medicare doesn't require orders for diagnostic lab tests
  • D. Not supported; the treating practitioner who uses the result must order it.
Show answer and explanation

D. For the diagnostic lab test described here, Medicare requires an order from the physician treating the beneficiary, meaning the one who uses the results to manage the patient's specific problem. (Nonphysician practitioners are covered in a separate paragraph of the same rule.) An abnormal result (A) or a patient's request (B) doesn't replace an order. C is simply wrong.

Source: 42 CFR 410.32(a), ordering diagnostic tests.

Compliance and regulatory guidelines

Question 9 · CPMA-P09 · False Claims Act knowledge

A billing manager got three internal warnings that a code the practice bills to Medicare isn't supported by documentation. She kept submitting the claims without looking into it. No one can show she meant to defraud anyone. Can her conduct meet the civil False Claims Act's "knowingly" standard?

  • A. No; the government must prove she specifically intended to defraud Medicare.
  • B. No; only actual knowledge that the claims were false meets the standard.
  • C. Yes; reckless disregard or deliberate ignorance can meet it.
  • D. No; the Act reaches physicians who bill, not the staff who submit claims.
Show answer and explanation

C. The False Claims Act defines "knowingly" to include actual knowledge, deliberate ignorance, and reckless disregard of the truth, and it says no proof of specific intent to defraud is required. Ignoring repeated warnings is the kind of conduct those terms reach. A and B state a narrower standard than the statute. D has no basis; the Act covers any person who submits or causes false claims. Whether liability exists is a legal question for counsel; this question tests the standard.

Source: 31 U.S.C. 3729(a)(1)(A) and (b)(1), False Claims Act liability and knowledge standard.

Question 10 · CPMA-P10 · Qui tam lawsuits

A former coder files a False Claims Act lawsuit against her old employer, alleging Medicare billing fraud. What's true about how this kind of case starts?

  • A. It's filed in the government's name and stays sealed for at least 60 days.
  • B. She must report to OIG first and wait for OIG to file the case for her.
  • C. The complaint becomes public right away so the employer can respond to it.
  • D. Only the Department of Justice is allowed to file a False Claims Act case.
Show answer and explanation

A. A private person, called a relator, may bring a False Claims Act action for herself and the United States, in the government's name. The complaint is filed under seal and stays sealed for at least 60 days, which the government can ask to extend. B and D deny the private right of action. C gets the seal backwards.

Source: 31 U.S.C. 3730(b)(1)–(3), actions by private persons and seal period.

Question 11 · CPMA-P11 · Anti-Kickback Statute intent

A physician accepted payments from a lab in exchange for referring Medicare patients' tests to it. His attorney argues he can't have violated the Anti-Kickback Statute because he had never heard of the law. How does the statute treat that argument?

  • A. It's a complete defense, since the statute requires knowing its specific terms.
  • B. It doesn't matter, because the statute applies only to hospitals and labs.
  • C. Not by itself; actual knowledge of the statute or specific intent to violate it isn't required.
  • D. It's a complete defense, because the two parties never signed a written agreement.
Show answer and explanation

C. The Anti-Kickback Statute covers anyone who knowingly and willfully offers, pays, solicits, or receives remuneration to induce or reward federal health care program referrals. A separate subsection says a person need not have actual knowledge of the statute or specific intent to violate it. So not knowing the law existed isn't a defense on its own; that's why A fails. B and D invent limits that aren't in the statute.

Source: 42 U.S.C. 1320a-7b(b) and (h), Anti-Kickback Statute.

Question 12 · CPMA-P12 · Beneficiary inducements

A practice gives each Medicare patient a branded insulated lunch bag with a $25 retail value at every visit. Is that within OIG's interpretation of "nominal value" for items given to beneficiaries?

  • A. No; OIG's limit is $15 per item and $75 per patient per year.
  • B. Yes; anything under $50 per visit counts as nominal value to OIG.
  • C. Yes, as long as each patient's yearly total stays under $100.
  • D. Yes, at any value, as long as the practice never advertises the bags.
Show answer and explanation

A. OIG's 2016 policy statement interprets nominal value for items that aren't cash or cash equivalents as no more than $15 per item and $75 in the aggregate per patient on an annual basis. A $25 item fails the per-item limit on the first visit. B, C and D use thresholds or conditions OIG doesn't recognize.

Source: HHS-OIG Policy Statement Regarding Gifts of Nominal Value (Dec. 7, 2016).

Question 13 · CPMA-P13 · Excluded individuals

A practice learns that its billing clerk appears on OIG's List of Excluded Individuals/Entities (LEIE). She handles the practice's Medicare billing but doesn't see patients, and none of her work is billed separately. What's the issue?

  • A. The practice has exposure; the payment ban covers her administrative work.
  • B. No issue, because she never provides or bills for any patient care herself.
  • C. Exclusion only matters for licensed clinicians who order or furnish services.
  • D. The practice broke a federal law that requires checking the LEIE every day.
Show answer and explanation

A. OIG's bulletin on the effect of exclusion says the payment ban covers items and services furnished by an excluded person that are payable directly or indirectly by federal health care programs, including administrative and management services that aren't separately billable. That's why B and C are wrong. D overstates the screening duty: OIG recommends routine screening and says monthly checks best limit liability, but no statute sets a daily requirement.

Source: HHS-OIG Special Advisory Bulletin on the Effect of Exclusion (May 8, 2013); HHS-OIG, Exclusions Program and LEIE.

Question 14 · CPMA-P14 · Corporate Integrity Agreements

A health system settles a False Claims Act case and signs a Corporate Integrity Agreement (CIA) with OIG. What should its compliance staff expect?

  • A. A one-year voluntary plan with no outside reviews or reports required
  • B. A five-year term, with reviews by an independent review organization
  • C. Automatic and permanent exclusion of the system from the Medicare program
  • D. An agreement with the state Medicaid agency only, not with federal OIG
Show answer and explanation

B. OIG says the period of a CIA is five years. CIAs require the entity to hire an independent organization to perform reviews, along with provisions such as a compliance officer, implementation and annual reports, and reporting of overpayments and reportable events. A CIA is OIG's alternative to exclusion, not exclusion itself, which rules out C. A and D misdescribe the agreement.

Source: HHS-OIG, Corporate Integrity Agreements.

Question 15 · CPMA-P15 · Self-referral disclosure

An internal review finds that a physician's office lease with a hospital he refers Medicare patients to lacked a signed written agreement for part of its term. Counsel concludes the conduct raises only physician self-referral (Stark) law issues, with no Anti-Kickback concern. Which voluntary self-disclosure protocol fits this conduct?

  • A. CMS's Self-Referral Disclosure Protocol
  • B. OIG's Health Care Fraud Self-Disclosure Protocol
  • C. A routine refund to the Medicare contractor, with no disclosure protocol
  • D. Nowhere, because Stark compliance is voluntary
Show answer and explanation

A. CMS's Self-Referral Disclosure Protocol is for actual or potential violations of the physician self-referral statute, and OIG's protocol says conduct that raises only self-referral issues should go to CMS. B excludes Stark-only arrangements. C is a refund route, not the voluntary self-disclosure protocol the question asks for. D: the self-referral law isn't optional.

Source: CMS, Self-Referral Disclosure Protocol; HHS-OIG Health Care Fraud Self-Disclosure Protocol (Oct. 15, 2026), §§2.B–C, pp. 5–6.

Question 16 · CPMA-P16 · Overpayments from simple errors

An internal audit finds a pattern of honest coding errors that caused Medicare overpayments. There's no sign of potential fraud and no self-referral issue. Which route fits?

  • A. Report and return them through the Medicare contractor's refund process.
  • B. Submit the matter through OIG's Health Care Fraud Self-Disclosure Protocol.
  • C. Submit the matter through CMS's Self-Referral Disclosure Protocol instead.
  • D. Keep the money until a Medicare contractor asks for it back in writing.
Show answer and explanation

A. OIG's Self-Disclosure Protocol isn't available for matters that involve only overpayments or errors; those go to the Medicare contractor through its refund process. B addresses eligible conduct with potential civil or administrative liability for which OIG can impose civil monetary penalties; criminal self-disclosures go to DOJ. C is for physician self-referral issues. D ignores the provider's own duty to report and return identified overpayments within the regulatory deadline.

Source: HHS-OIG Health Care Fraud Self-Disclosure Protocol (Oct. 15, 2026), §§2.B–C, pp. 5–6; 42 CFR 401.305, reporting and returning overpayments.

Question 17 · CPMA-P17 · Recovery Audit Contractor look-back

A Medicare Fee-for-Service Recovery Audit Contractor (RAC) sends a records request for a claim that was first paid four years ago. Under CMS's RAC Statement of Work, what's the problem?

  • A. None, because RAC reviews can look back as far as six years from payment.
  • B. None, because RAC reviews can look back as far as ten years from payment.
  • C. RACs can't review claims more than three years past the first paid date.
  • D. None, because no time limit applies once an overpayment is suspected.
Show answer and explanation

C. CMS's Statement of Work says a RAC shall not review claims or identify improper payments more than three years past the initial claim paid date. For a records-based review, that period runs from the initial payment date to the date the RAC issues its additional documentation request (ADR) letter. A claim first paid four years ago is outside that window. A, B and D misstate the limit. Other contractors and investigations follow their own rules, so this answer is specific to RAC reviews.

Source: CMS Recovery Audit Contractor Statement of Work, Regions 3–5 (Apr. 28, 2025), Task 3 §B, p. 18.

Question 18 · CPMA-P18 · Status of OIG compliance guidance

While rewriting policies, a compliance manager tells staff that every "should" in OIG's General Compliance Program Guidance (GCPG) is now a binding legal requirement. What's the best correction?

  • A. She's right; the GCPG was issued as a binding federal regulation in 2023.
  • B. The GCPG replaced the False Claims Act and the Anti-Kickback Statute.
  • C. The GCPG applies only to hospitals, so physician practices can ignore it.
  • D. The GCPG is voluntary guidance; it creates no new legal obligations.
Show answer and explanation

D. OIG describes the GCPG as voluntary guidance that isn't binding on any individual or entity and doesn't create any new law or legal obligations. It summarizes laws that do bind providers and recommends how to build a compliance program. A confuses guidance with regulation. B gets it backwards. C: the general guidance is written for the health care industry broadly.

Source: HHS-OIG General Compliance Program Guidance (Nov. 2023), User's Guide and p. 10.

Coding and reimbursement concepts

Question 19 · CPMA-P19 · Minor procedure global period

A physician performs a minor procedure with a 10-day Medicare global period on September 14, 2026. The same physician billed an office visit on September 13. Is September 13 inside the global period?

  • A. No; a 10-day global has no pre-operative day.
  • B. Yes; the day before any surgery is always inside the global period.
  • C. Yes, but only when that visit is billed with modifier 57 attached.
  • D. Yes; minor procedures carry a 30-day pre-operative window.
Show answer and explanation

A. A procedure with a 10-day Medicare global period has 11 days in the package: the day of the procedure and the following 10 days, with no pre-operative period. The day-before rule in B belongs to major procedures, whose global covers the day before, the day of, and 90 days after (92 days). C and D have no basis. Whether the September 13 visit is separately payable still depends on its documentation.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), p. 4.

Question 20 · CPMA-P20 · MUE aggregation across lines

A Medicare code has a date-of-service Medically Unlikely Edit (MUE) of 2 units. One provider's claim reports that code on two lines for the same patient and date: 2 units on one line and 1 unit on the other. What is the edit result when no override is applied?

  • A. Each line is checked on its own, so both lines are paid in full.
  • B. Only the one extra unit is denied, and the other 2 units are paid.
  • C. Only the first line is paid, and the second line is denied entirely.
  • D. Units are summed across lines; all units of the code are denied.
Show answer and explanation

D. For a date-of-service MUE (adjudication indicator 2 or 3), CMS sums all units of the code on all claim lines for that date. If the sum exceeds the MUE value, all units of the code on the claim are denied. Splitting units across lines (A) doesn't avoid the edit, and B and C describe partial payment the edit doesn't make. With an indicator of 3, a contractor may pay more units on appeal when records show they were furnished, correctly coded, and medically necessary.

Source: CMS Medicare NCCI FAQ Library, MUE FAQs 3–4; CMS NCCI Policy Manual for Medicare Services (2026), ch. I, §V, pp. I-28–I-29.

Question 21 · CPMA-P21 · MUE denials and ABNs

Units of a service are denied because they exceed an MUE. Before the service, the patient signed an ABN. Can the practice bill the patient for the denied units?

  • A. Yes, as long as the claim line carries modifier GA for the signed ABN.
  • B. Yes, as long as the patient also agreed verbally to pay for the units.
  • C. No; an MUE denial is a coding denial, so an ABN can't shift it.
  • D. Yes, as long as the claim line carries modifier GZ for the denied units.
Show answer and explanation

C. CMS says an MUE denial is a coding denial, not a medical necessity denial, and an ABN can't be used to bill the beneficiary for units denied by an MUE. A and D misuse ABN modifiers: GA reports that a required ABN was issued and GZ reports that one wasn't, but neither applies to coding denials. B isn't a valid way to shift liability either.

Source: CMS NCCI Policy Manual for Medicare Services (2026), ch. I, §V, p. I-32; CMS Medicare NCCI FAQ Library, MUE FAQ 10; CMS MLN006266, Medicare Advance Written Notices of Non-coverage (May 2025), p. 11, Table 2.

Question 22 · CPMA-P22 · What NCCI edits prove

A claim passes every NCCI procedure-to-procedure and MUE edit. A reviewer concludes the services must have been medically necessary and covered. Is that conclusion supported?

  • A. Yes; passing NCCI edits confirms the services were medically necessary.
  • B. No; NCCI edits check correct coding, not medical necessity.
  • C. Yes, but only for evaluation and management services on the claim.
  • D. Yes, as long as every code's units stay below its MUE value.
Show answer and explanation

B. CMS says NCCI edits are correct coding edits, not medical necessity edits. It also says MUE values aren't utilization guidelines, so claims within them can still undergo medical review. Coverage and medical necessity are separate questions an auditor still has to answer from the record. A, C and D all treat edit clearance as proof it can't provide.

Source: CMS Medicare NCCI FAQ Library, General FAQ 3 and MUE FAQ 13.

Question 23 · CPMA-P23 · Choosing an X modifier

A hypothetical Medicare procedure-to-procedure (PTP) edit pairs two services, and its modifier indicator is 1. The same physician performed both for the same patient on the same date, at two separate encounters: one in the morning and one in the afternoon. The record supports both. Which modifier describes the distinction?

  • A. XS
  • B. XP
  • C. XE
  • D. XU
Show answer and explanation

C. XE identifies a service that's distinct because it occurred during a separate encounter. A (XS) is for a separate organ or structure. B (XP) is for a different practitioner, but one physician did both. D (XU) is for an unusual non-overlapping service that does not overlap usual components of the main service. An indicator of 1 only permits a modifier when the circumstances qualify; the documentation still has to support it, and a different diagnosis alone isn't enough.

Source: CMS MLN1783722, Proper Use of Modifiers 59, XE, XP, XS and XU (Apr. 2026), pp. 3-4 and 6.

Question 24 · CPMA-P24 · Incident-to supervision

In September 2026, a nurse provides an Original Medicare follow-up service in a physician's office that's billed incident-to the physician and requires direct supervision. The service isn't one with a 10- or 90-day global period. Throughout, the physician was at another location and reachable only by an audio-only phone call. No other eligible practitioner supervised the service. What's the finding?

  • A. Not supported; audio-only contact doesn't meet direct supervision.
  • B. Supported, because phone availability counts as direct supervision.
  • C. Supported, because every incident-to service needs only general supervision.
  • D. Supported, as long as the physician reviews and signs the note afterward.
Show answer and explanation

A. Incident-to services generally require direct supervision. For in-person direct supervision, the physician is in the office suite and immediately available. Under the current rule, real-time audio and video interaction can satisfy direct supervision for services without a 010 or 090 global indicator, but audio-only can't. That rules out B. C overstates the exceptions: only certain services, such as behavioral health and designated care management, allow general supervision. D: signing later doesn't create supervision that didn't happen.

Source: 42 CFR 410.26(a)(2)–(3) and (b)(5), incident-to supervision; 42 CFR 410.32(b)(3)(ii), definition of direct supervision; CMS CY2026 Physician Fee Schedule final-rule fact sheet (Oct. 31, 2025), Telehealth Services under the PFS.

Question 25 · CPMA-P25 · Diagnosis from a lab value

On a September 15, 2026 office claim, you see a lab result above the reference range. The physician's note doesn't document any diagnosis related to it, and no guideline exception applies. A coder added a disease code based on the lab value alone. What's the finding?

  • A. Supported, because an abnormal lab value is enough to establish the disease.
  • B. Not supported; codes come from the provider's diagnostic statement.
  • C. Supported, because the added diagnosis code increases the claim's payment.
  • D. Supported, because the practice's coding software suggested that code.
Show answer and explanation

B. The ICD-10-CM guidelines say a diagnosis code is assigned based on the provider's diagnostic statement that the condition exists, not on clinical criteria applied by the coder. A lab value (A), a payment effect (C), or a software suggestion (D) doesn't replace the provider's documentation.

Source: ICD-10-CM Official Guidelines, FY2026 (updated April 1, 2026), Section I.A.19, p. 12.

Scope and statistical sampling methodologies

Question 26 · CPMA-P26 · Probability samples

To estimate an overpayment across a provider's paid Medicare claims, which selection method produces a probability sample under CMS's sampling instructions?

  • A. The auditor hand-picks the claims that look the most typical of the group
  • B. Claims are selected starting with the highest-dollar claims in the group
  • C. Random selection where every unit has a known, non-zero chance
  • D. Every claim submitted during the provider's single busiest week
Show answer and explanation

C. CMS's Program Integrity Manual defines a probability sample as one where every sampling unit has a known, non-zero chance of selection and units are chosen randomly. A is a judgment sample. B and D leave most units with no chance of being chosen, so the result can't support a valid estimate for the whole group.

Source: Medicare Program Integrity Manual, ch. 8, §8.4.2, PDF p. 36.

Question 27 · CPMA-P27 · Sampling units

A reviewer says, "In a Medicare overpayment sample, the sampling unit must always be a whole claim." Is that right?

  • A. Yes; CMS allows only whole claims to serve as the sampling unit.
  • B. No; under CMS's rules the sampling unit must always be a single beneficiary.
  • C. No; the auditor may switch units partway through the review as needed.
  • D. No; it can be a claim line, a claim, or a cluster such as a beneficiary.
Show answer and explanation

D. CMS says the sampling unit may be a line item, a claim, or a cluster, such as a beneficiary or a treatment day. A and B are too narrow. C breaks the design: the unit is defined in the plan before selection, and the case file has to document enough to replicate the sample.

Source: Medicare Program Integrity Manual, ch. 8, §§8.4.3.2, 8.4.3.2.2 and 8.4.4.2, PDF pp. 38–40.

Question 28 · CPMA-P28 · Universe and sampling frame

An audit plan's target is all paid Medicare office-visit claims for a practice in the second quarter of 2026. The sampling frame actually built contains only one clinician's claims that a billing alert flagged. What must change before the results can estimate an error rate for the full target population?

  • A. Nothing needs to change, as long as the sample size is large enough.
  • B. Nothing, as long as the flagged claims are picked at random from that list.
  • C. Redefine the target population after seeing which claims had errors.
  • D. Rebuild the frame to match the target, then draw a probability sample.
Show answer and explanation

D. The universe is the target population of claims, and the sampling frame is the list of units that can actually be selected. A frame that holds only flagged claims for one clinician doesn't represent paid office-visit claims for the whole practice, no matter how large the sample (A) or how randomly it's drawn from the wrong list (B). C would bias the result. A flagged-claims review is still useful; it just answers a narrower question.

Source: Medicare Program Integrity Manual, ch. 8, §§8.4.2 and 8.4.3.2, PDF pp. 36 and 38.

Question 29 · CPMA-P29 · Combining error rates

Two non-overlapping reviews use the same error definition. Review 1 found errors in 5 of 20 claims. Review 2 found errors in 5 of 80 claims. What share of all 100 reviewed claims had an error?

  • A. 15.6%
  • B. 10%
  • C. 31.25%
  • D. 5%
Show answer and explanation

B. Add the counts, then divide: (5 + 5) / (20 + 80) = 10 / 100 = 10%. A averages the two rates, (25% + 6.25%) / 2 = 15.625%, rounded to 15.6%, which gives the small review the same weight as the large one. C adds the two rates. D divides one review's errors by both reviews' claims. This 10% describes the reviewed claims only; it isn't an estimate for unreviewed claims.

Source: Original fictional inputs; arithmetic shown above.

Quality assurance and risk analysis

Question 30 · CPMA-P30 · Validating a finding by date

You're validating another auditor's diagnosis-coding finding on a September 15, 2026 outpatient encounter. The auditor applied the FY2027 ICD-10-CM guidelines because that's the newest file online today. What should the validation check?

  • A. Nothing; the newest guideline file available online always controls
  • B. That it applies the version in effect on the date the audit is done
  • C. Nothing; every guideline version released during 2026 is interchangeable
  • D. That it applies the version in effect on the date of service
Show answer and explanation

D. For outpatient encounters, code sets and guidelines apply by date of service. The FY2026 guidelines as updated April 1, 2026 cover April 1 through September 30, 2026; the FY2027 release took effect October 1, 2026. A and B tie the rule to the wrong date. C ignores that versions change. (This is about auditing real claims. AAPC builds its exams on calendar-year code sets, which is a separate question.)

Source: ICD-10-CM Official Guidelines, FY2026 April 1, 2026 update, cover page (effective April 1 to September 30, 2026); CDC, ICD-10-CM files and effective dates; AAPC, Which year's books should I use?.

Communication of results and findings

Question 31 · CPMA-P31 · Escalating possible fraud

During a routine coding audit, you find records suggesting that a provider billed for visits that may never have happened. What's the best next step?

  • A. Educate the provider on documentation rules and then close the audit.
  • B. Escalate to the compliance officer and counsel for evaluation.
  • C. Quietly correct the affected claims in the billing system yourself.
  • D. Present the findings to the provider during the next staff meeting.
Show answer and explanation

B. Possible billing for services not rendered goes beyond a coding-education issue. OIG's compliance guidance recommends that organizations respond to detected problems, with compliance leadership and counsel evaluating whether disclosure is appropriate and which process applies. A treats a possible fraud issue as a training gap. C hides the problem. D exposes unverified findings and the people involved.

Source: HHS-OIG General Compliance Program Guidance (Nov. 2023), §§III.G.1–2, pp. 60–62; HHS-OIG Health Care Fraud Self-Disclosure Protocol (Oct. 15, 2026), §§2.B–C, pp. 5–6.

Question 32 · CPMA-P32 · Writing a finding

A validated review found that a billing-system rule added a modifier the records didn't support. Which report statement communicates the finding best?

  • A. "Dr. Lee committed billing fraud on Q2 claims and should be reported to the authorities right away."
  • B. "12 of 40 sampled Q2 2026 claims (30%) carried a system-added modifier the record didn't support under the cited rule. Billing will fix the logic; a follow-up review will recheck claims."
  • C. "The error rate on reviewed claims was high this quarter, and staff need to be much more careful going forward."
  • D. "Billing staff attended a modifier training session after the review, so the issue is now fully resolved."
Show answer and explanation

B. A useful finding states the evidence with its denominator (12 / 40 = 30%), the rule, the cause, who owns the fix, and how the fix will be checked. That matches OIG's emphasis on corrective action and follow-up monitoring. A makes an accusation the evidence doesn't support and blames a person for a system defect. C gives no numbers, rule, or owner. D treats training attendance as proof the problem is fixed.

Source: HHS-OIG General Compliance Program Guidance (Nov. 2023), §III.F.2, pp. 58–59, and §III.G.3, p. 63.

Audit cases

These seven fictional records follow AAPC's list of case specialties. Read the whole record before its questions, and use your code books the way you would on exam day.

Case 1: Office E/M visit

Audit record (fictional)

  • Setting: Physician office, established patient, Original Medicare. Date of service: September 10, 2026.
  • Note excerpt: Type 2 diabetes, worsening since the last visit: the patient's home glucose readings are consistently above goal. The physician increases the dose of the patient's prescription oral diabetes medicine.
  • Data documented: The physician reviewed the discharge summary from the patient's recent stay at an outside hospital (one outside source). The physician ordered an A1c and a lipid panel for the next visit. A 12-lead ECG was performed in the office today; this physician interpreted it and wrote the report.
  • Time: No total time is documented.
  • Claim as submitted: 99215 and 93000 (routine ECG with interpretation and report).

Question 33 · CPMA-P33 · E/M data element

Case 1. Which level does the documentation support for the MDM data element?

  • A. Moderate
  • B. Minimal or none
  • C. Limited
  • D. Extensive
Show answer and explanation

A. Moderate data needs one of three categories. Category 1 needs any three of: reviewing prior external notes from each unique source, reviewing the result of each unique test, ordering each unique test, or an assessment that needs an independent historian. Here there are three: the outside hospital's discharge summary and two unique tests ordered. B and C undercount. D needs two of the three categories, and the ECG can't count as an independent interpretation because this physician reports the ECG.

Source: AMA, CPT E/M guidelines, Table 1 (Levels of MDM) and definitions.

Question 34 · CPMA-P34 · Independent interpretation

Case 1. Can the physician's ECG interpretation count toward MDM as an independent interpretation of a test?

  • A. No, because the physician is reporting the ECG separately
  • B. Yes, because the interpretation is documented in today's note
  • C. Yes, because an ECG reading always counts as independent
  • D. Only if the patient were new to the practice rather than established
Show answer and explanation

A. The AMA guidelines say an independent interpretation doesn't count when the physician is reporting, or has previously reported, the test. Billing 93000, the complete ECG including the interpretation and report, means the work is being reported separately. Documentation alone (B) doesn't change that. C and D have no basis.

Source: AMA, CPT E/M guidelines, p. 17, Independent interpretation; CMS article A54953, code entry for 93000.

Question 35 · CPMA-P35 · Supported E/M level

Case 1. Which office visit level does the documentation support?

  • A. 99215
  • B. 99213
  • C. 99214
  • D. 99212
Show answer and explanation

C. MDM is set by two of three elements. Problems: a chronic illness with progression is moderate. Data: moderate (Question 33). Risk: prescription drug management is moderate. Moderate MDM supports 99214 for an established patient. A needs high MDM, and no element reaches high. B and D sit below the supported level. No time is documented, so time can't support a different level.

Source: AMA, CPT E/M guidelines, Table 1 (Levels of MDM) and definitions; AMA, CPT code 99214, Care components (updated Jan. 26, 2026).

Case 2: Surgery and the global period

Audit record (fictional)

  • Setting: Same surgeon throughout, Original Medicare.
  • July 20, 2026: Office visit at which the surgeon and patient decide on surgery.
  • August 2, 2026: Routine pre-operative office visit, billed as 99213 with no modifier.
  • August 3, 2026: Major procedure with a 90-day global period. The operative note says a second-stage procedure is planned once the first stage heals.
  • August 20, 2026: Unplanned return to the operating room to evacuate a hematoma at the surgical site.
  • September 15, 2026: The planned second-stage procedure is performed.

Question 36 · CPMA-P36 · Pre-operative visit

Case 2. How should the August 2 office visit be treated?

  • A. It's separately payable as long as modifier 57 is appended to it.
  • B. It's included in the global package, not separately payable.
  • C. It's separately payable as billed, with no modifier needed at all.
  • D. It's separately payable as long as modifier 24 is appended to it.
Show answer and explanation

B. For a major procedure, pre-operative visits after the decision for surgery, starting the day before surgery, are included in the global package. The decision was made on July 20, so the August 2 visit is routine pre-op care. A: modifier 57 identifies the initial decision for major surgery when the E/M occurs on the day before or the day of surgery. The August 2 visit did not make that decision; July 20 was outside that window. C ignores the global package. D: modifier 24 is for an unrelated E/M during the postoperative period.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), pp. 5 and 9.

Question 37 · CPMA-P37 · Unplanned return to the OR

Case 2. Which modifier fits the August 20 procedure?

  • A. 58
  • B. 79
  • C. 24
  • D. 78
Show answer and explanation

D. Modifier 78 reports an unplanned return to the operating room for a related problem during the postoperative period, such as evacuating a hematoma at the surgical site. A (58) is for staged, planned, or more extensive related procedures, and this one wasn't planned. B (79) is for an unrelated procedure. C (24) is for an unrelated E/M service, not a procedure.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), p. 14.

Question 38 · CPMA-P38 · Staged procedure

Case 2. Which modifier fits the September 15 procedure, and what happens to the global period?

  • A. Modifier 58; a new postoperative period begins.
  • B. Modifier 78; the original global period continues.
  • C. Modifier 79; the original global period continues.
  • D. No modifier; the original global package covers it.
Show answer and explanation

A. Modifier 58 reports a staged or related procedure that was planned at the time of the original procedure. The operative note documented the plan, and CMS says a new postoperative period starts with the next procedure in the series. B: 78 is for unplanned returns. C: 79 is for unrelated procedures. D treats a planned, separately reportable procedure as included care.

Source: CMS MLN907166, Global Surgery Booklet (Dec. 2025), p. 14.

Case 3: Physical therapy

Audit record (fictional)

  • Setting: Outpatient physical therapy, Medicare Part B. One therapist, one patient. Date of service: September 25, 2026.
  • Treatment log: Therapeutic exercise, 21 minutes of direct one-on-one treatment. Manual therapy, 13 minutes of direct one-on-one treatment. Between the two, the patient waited 9 minutes with no treatment. Both services are billed with timed 15-minute codes and are separately reportable on these facts.
  • Plan of care: The initial evaluation and treatment began June 1, 2026, and the physician certified the plan that day. Treatment continued under that plan through September 25. No recertification, timely or delayed, is on file, and no significant change in the plan is documented.
  • Claim as submitted: 3 timed units (2 therapeutic exercise, 1 manual therapy).

Question 39 · CPMA-P39 · Total timed units

Case 3. How many timed units does the treatment log support?

  • A. 3
  • B. 1
  • C. 4
  • D. 2
Show answer and explanation

D. Medicare counts direct, one-on-one treatment time for timed codes: 21 + 13 = 34 minutes. Under the 8-minute rule, 23 to 37 minutes supports 2 units. The 9 minutes of waiting wasn't treatment, so it doesn't count. A adds the waiting time (43 minutes, which would support 3 units). B undercounts. C would need at least 53 minutes.

Source: Medicare Claims Processing Manual, ch. 5, §§20.2–20.3 (timed codes and treatment time).

Question 40 · CPMA-P40 · Allocating units

Case 3. How should the supported timed units be split between the two services?

  • A. 2 units of therapeutic exercise and none of manual therapy
  • B. 2 units of manual therapy and none of therapeutic exercise
  • C. 1 unit of therapeutic exercise and 1 unit of manual therapy
  • D. 2 units of therapeutic exercise and 1 unit of manual therapy
Show answer and explanation

C. The 34 direct minutes support 2 units (see the previous question). CMS assigns them by comparing time. Therapeutic exercise's 21 minutes covers one full 15-minute unit with 6 minutes left over. Manual therapy's 13 minutes is more than those 6 leftover minutes, so the second unit goes to manual therapy. A gives both units to the longer service without comparing the remaining time. B reverses the logic. D bills 3 units, more than the 34 minutes support.

Source: Medicare Claims Processing Manual, ch. 5, §§20.2–20.3 (timed codes and treatment time).

Question 41 · CPMA-P41 · Plan of care recertification

Case 3. What's the finding on the plan of care for the September 25 visit?

  • A. Supported; a plan of care certification remains valid for one full year.
  • B. Not supported by the records provided; required recertification is missing.
  • C. Supported; the therapist may recertify the plan without the physician.
  • D. Supported; only the initial certification is required for the episode.
Show answer and explanation

B. Medicare requires the plan of care to be recertified at least every 90 days, or sooner if the plan changes significantly. The interval runs from the initial treatment under the plan, including the evaluation, not merely the signature date. From June 1 to September 25 is 116 days, and no recertification is on file. A and D misstate the rule. C: recertification comes from the physician or other qualified practitioner, not the therapist alone. An acceptable delayed recertification may resolve this record defect; the unit calculation in Questions 39 and 40 does not resolve it.

Source: 42 CFR 424.24(c)(4), therapy plan of care recertification; Medicare Benefit Policy Manual, ch. 15, §220.1.3B–E, PDF pp. 162–165.

Case 4: Radiology

Audit record (fictional)

  • Setting: Private-practice radiology group reading for a hospital outpatient department. The hospital owns the equipment and bills its own component. Original Medicare.
  • September 8, 2026, Patient X: Chest x-ray, two views. The radiologist interprets the images and signs a written report. Claim: 71046 with no modifier.
  • September 9, 2026, Patient Y: Chest x-ray, two views. The radiologist ticks a box marked "normal" on the order form. No report is written. Claim: 71046-26.

Question 42 · CPMA-P42 · Professional component

Case 4. How should the radiology group report the September 8 study for Patient X?

  • A. 71046 with no modifier
  • B. 71046-26
  • C. 71046-TC
  • D. 71045-26
Show answer and explanation

B. The radiologist provided only the professional component (the interpretation and report). The hospital owns the equipment and bills its own part, so modifier 26 belongs on the group's claim. A claims both components. C is the technical component, which the hospital furnished. D (71045) is a single-view chest x-ray, but two views were taken.

Source: Medicare Claims Processing Manual, ch. 13, §20.1 (professional component); CMS article A54953, code entries for 71045–71046.

Question 43 · CPMA-P43 · Interpretation without a report

Case 4. What's the finding for the September 9 claim for Patient Y?

  • A. Not supported; an interpretation includes a written report.
  • B. Supported, because the radiologist did review the images that day.
  • C. Supported, because the order form records the result of the study.
  • D. Supported, as long as the hospital also billed the technical component.
Show answer and explanation

A. CMS says the interpretation of a diagnostic procedure includes a written report. A ticked box on the order form isn't a report. B and C treat a review without a report as a billable interpretation. D: the hospital's own claim doesn't supply the radiologist's missing report.

Source: Medicare Claims Processing Manual, ch. 13, §20.1 (professional component).

Case 5: Psychiatry

Audit record (fictional)

  • Setting: Psychiatrist's office, Original Medicare, September 2026.
  • Visit A, established patient: A significant, separately identifiable E/M service for medication management, plus 50 minutes of psychotherapy. The E/M time isn't counted in the 50 minutes. Claim: 99213 + 90838.
  • Visit B, new patient: The psychiatrist performs a psychiatric diagnostic evaluation. Claim: 90791 and 99204 for the same date.

Question 44 · CPMA-P44 · Psychotherapy add-on with E/M

Case 5. Which psychotherapy add-on code does Visit A support?

  • A. 90836
  • B. 90838, as billed
  • C. 90837
  • D. 90833
Show answer and explanation

A. When psychotherapy accompanies an E/M service, it's reported with an add-on code chosen by time: 90833 for 16 to 37 minutes, 90836 for 38 to 52 minutes, and 90838 for 53 minutes or more. Fifty minutes falls in the 90836 band. B needs at least 53 minutes. C (90837) is the stand-alone psychotherapy code, not the add-on used with an E/M. D undercounts the time.

Source: CMS article A57520, Psychiatric Diagnostic Evaluation and Psychotherapy Services, Coding Guidance; CMS NCCI Policy Manual for Medicare Services (2026), ch. XI, §C, p. XI-7.

Question 45 · CPMA-P45 · Diagnostic evaluation and E/M

Case 5. What's the finding for Visit B?

  • A. Both are payable if modifier 25 is added to the E/M.
  • B. Both are payable if 90792 replaces 90791.
  • C. Both are payable if interactive complexity (90785) is added.
  • D. The E/M can't be reported with 90791 for the same date.
Show answer and explanation

D. CMS's NCCI policy says E/M codes, such as 99202-99215, shall not be reported with the psychiatric diagnostic evaluation codes 90791 or 90792. A treats a modifier as a way around a policy prohibition. B swaps in a code covered by the same prohibition. C: interactive complexity is an add-on and doesn't make the pair reportable.

Source: CMS NCCI Policy Manual for Medicare Services (2026), ch. XI, §C, p. XI-7; CMS article A57520, Psychiatric Diagnostic Evaluation and Psychotherapy Services, Coding Guidance.

Case 6: Chemotherapy administration

Audit record (fictional)

  • Setting: Oncology physician office, Medicare Part B, September 2026.
  • Administration: IV chemotherapy infusion lasting 1 hour 25 minutes. Normal saline hydration ran at the same time through the same line during the chemotherapy.
  • Drug A: Supplied only in a 100 mg single-dose vial. Its HCPCS billing unit is 10 mg. The record shows 60 mg administered and 40 mg discarded. There's no overfill and no other vial. Drug A is separately payable under Medicare Part B and subject to the JW/JZ reporting policy.
  • Claim as submitted: Initial chemotherapy infusion (first hour) + one additional chemotherapy hour + initial hydration; Drug A, 10 units on one line with modifier JZ.

Question 46 · CPMA-P46 · Additional infusion hour

Case 6. Is the additional chemotherapy hour supported?

  • A. Yes, because the infusion ran for longer than one full hour.
  • B. Yes, as long as start and stop times are documented in the record.
  • C. Yes, because the concurrent hydration extended the total infusion time.
  • D. No; it needs more than 30 minutes beyond the first hour.
Show answer and explanation

D. CMS says an "each additional hour" code needs an interval greater than 30 minutes beyond the hour. A 1-hour-25-minute infusion has 25 minutes after the first hour, which isn't enough. A counts any time past an hour. B: documented times are needed, but they still have to meet the threshold. C: the concurrent hydration doesn't add chemotherapy time.

Source: Medicare Claims Processing Manual, ch. 12, §30.5.E, PDF pp. 34–35 (drug administration).

Question 47 · CPMA-P47 · Concurrent hydration

Case 6. Is the hydration separately reportable?

  • A. Yes, as the initial service, because the hydration bag was hung first.
  • B. Yes, as a sequential infusion reported after the chemotherapy service.
  • C. No; hydration given concurrently with chemotherapy isn't reported.
  • D. Yes, as long as the hydration ran for longer than the chemotherapy did.
Show answer and explanation

C. CMS's NCCI policy says hydration given concurrently with chemotherapy or other drug administration isn't separately reportable. The record shows the saline ran during the chemotherapy through the same line. A and B would report it as its own service, and D invents a condition.

Source: CMS NCCI Policy Manual for Medicare Services (2026), ch. XI, §N.6, p. XI-25.

Question 48 · CPMA-P48 · Drug units and discarded amounts

Case 6. How should Drug A be reported?

  • A. 10 units on one line with modifier JZ, exactly as billed
  • B. 6 units on one line with modifier JZ, and no line for the discard
  • C. 6 units on one line; 4 units with JW on a second line
  • D. 1 unit on one line, because only one single-dose vial was used
Show answer and explanation

C. With a 10 mg billing unit, 60 mg administered is 6 units and 40 mg discarded is 4 units. CMS's FAQs show the administered amount on one line and the discarded amount on another line with JW. JZ attests that nothing was discarded, which is false here, so A and B misreport the claim. A also bills the discard as if it were administered. D counts vials instead of billing units.

Source: Original fictional inputs; arithmetic shown above; CMS JW and JZ Modifier Policy FAQs, Q1, Q2 and Q15.

Case 7: Infusion services

Audit record (fictional)

  • Setting: Physician office, Original Medicare, September 2026.
  • Reason for visit: Scheduled IV antibiotic therapy. The antibiotic infuses for 40 minutes.
  • Before the antibiotic: The nurse gives an antiemetic IV over 12 minutes.
  • IV access: A second IV site was started "for convenience." No medical reason for a second site is documented.
  • Claim as submitted: IV push for the antiemetic reported as the initial service, and an initial therapeutic infusion code for the antibiotic on the second site.

Question 49 · CPMA-P49 · Initial administration code

Case 7. Which service should be reported as the initial drug administration service?

  • A. The antiemetic push, because it was given first
  • B. The therapeutic infusion of the antibiotic
  • C. Both, because they were different drugs
  • D. Neither, because hydration is always reported first
Show answer and explanation

B. For physician reporting, CMS says the initial code is the one that best describes the key or primary reason for the encounter, regardless of the order the services were given. The patient came in for IV antibiotic therapy. A uses order of administration. C breaks the one-initial-code limit. D has no basis. The 12-minute antiemetic is still reportable as an IV push, because CMS treats an infusion of 15 minutes or less as a push.

Source: Medicare Claims Processing Manual, ch. 12, §30.5.E, PDF pp. 34–35 (drug administration).

Question 50 · CPMA-P50 · Second IV site

Case 7. Does the second IV site, placed only for convenience, justify reporting two initial drug administration codes at this encounter?

  • A. Yes, because a second IV site was actually placed during the visit.
  • B. Yes, because a different drug was given through the second IV site.
  • C. No; a second initial code needs a medically necessary second site.
  • D. Yes, as long as each initial code is reported on its own claim line.
Show answer and explanation

C. CMS's NCCI policy allows one initial drug administration code per encounter unless separate IV sites are medically necessary. "For convenience" doesn't establish medical necessity. A, B and D each treat a setup detail as enough on its own. The antibiotic infusion remains the single initial service identified in Question 49; the second physical site does not justify another initial code.

Source: CMS NCCI Policy Manual for Medicare Services (2026), ch. XI, §B.2, p. XI-3; Medicare Claims Processing Manual, ch. 12, §30.5.E, PDF pp. 34–35 (drug administration).

Score your practice test

Count the questions you got right on your first try, out of 50. That number describes these 50 questions only. It isn't an AAPC score, and it doesn't predict whether you'll pass the CPMA.

Count only answers you chose before revealing the explanation. A reveal without an answer is unscored, and a choice made afterward is review. If you stop early, record how many you answered and how many remain unanswered; don't label an incomplete attempt as a completed 50-question result.

Then tally your correct answers by area. Most areas have only a few questions here, so read a low count as a list of rules to reread, not a measure of your skill in that area.

Score tally by content area: question range, number in set and your correct count
Content area Questions Number in set My correct
Medical record standards and documentation guidelines 1–8 8
Compliance and regulatory guidelines 9–18 10
Coding and reimbursement concepts 19–25 7
Scope and statistical sampling methodologies 26–29 4
Quality assurance and risk analysis 30 1
Communication of results and findings 31–32 2
Medical record auditing abstraction (cases) 33–50 18
Total 50

For each question you missed or guessed:

  1. Name the fact in the stem or record that decided the answer: a date, a minute count, who performed the service, what the documentation actually says.
  2. Open the source under the explanation and find the rule.
  3. Close the explanation and work the question again from the stem.

Repeating a question you've already seen is review, not a fresh test.

Error log (copy it into your notes):

Error log: question, what I missed, rule and source to reread, what I'll check next time
Question What I missed Rule and source to reread What I'll check next time
Example: Q39 Counted the 9 minutes of waiting as treatment time 8-minute rule, Medicare Claims Processing Manual ch. 5, §20.2 Add up only direct one-on-one treatment minutes

Want to time yourself? AAPC gives 4 hours for 100 questions, an average of 2.4 minutes each. At that pace, this set takes about 2 hours. That's a proportional pacing drill only; the real exam has more questions, more case work, and proctored conditions.

Answer key

Use this for a quick tally after you've worked the set. The teaching is in the explanation under each question.

Answer key: question number, item ID, answer and content area
Question ID Answer Content area
1 CPMA-P01 C Documentation
2 CPMA-P02 B Documentation
3 CPMA-P03 D Documentation
4 CPMA-P04 D Documentation
5 CPMA-P05 A Documentation
6 CPMA-P06 B Documentation
7 CPMA-P07 B Documentation
8 CPMA-P08 D Documentation
9 CPMA-P09 C Compliance
10 CPMA-P10 A Compliance
11 CPMA-P11 C Compliance
12 CPMA-P12 A Compliance
13 CPMA-P13 A Compliance
14 CPMA-P14 B Compliance
15 CPMA-P15 A Compliance
16 CPMA-P16 A Compliance
17 CPMA-P17 C Compliance
18 CPMA-P18 D Compliance
19 CPMA-P19 A Coding and reimbursement
20 CPMA-P20 D Coding and reimbursement
21 CPMA-P21 C Coding and reimbursement
22 CPMA-P22 B Coding and reimbursement
23 CPMA-P23 C Coding and reimbursement
24 CPMA-P24 A Coding and reimbursement
25 CPMA-P25 B Coding and reimbursement
26 CPMA-P26 C Sampling
27 CPMA-P27 D Sampling
28 CPMA-P28 D Sampling
29 CPMA-P29 B Sampling
30 CPMA-P30 D Quality assurance
31 CPMA-P31 B Communication
32 CPMA-P32 B Communication
33 CPMA-P33 A Record auditing (cases)
34 CPMA-P34 A Record auditing (cases)
35 CPMA-P35 C Record auditing (cases)
36 CPMA-P36 B Record auditing (cases)
37 CPMA-P37 D Record auditing (cases)
38 CPMA-P38 A Record auditing (cases)
39 CPMA-P39 D Record auditing (cases)
40 CPMA-P40 C Record auditing (cases)
41 CPMA-P41 B Record auditing (cases)
42 CPMA-P42 B Record auditing (cases)
43 CPMA-P43 A Record auditing (cases)
44 CPMA-P44 A Record auditing (cases)
45 CPMA-P45 D Record auditing (cases)
46 CPMA-P46 D Record auditing (cases)
47 CPMA-P47 C Record auditing (cases)
48 CPMA-P48 C Record auditing (cases)
49 CPMA-P49 B Record auditing (cases)
50 CPMA-P50 C Record auditing (cases)

How this set compares with the real CPMA

AAPC splits its 100 questions into seven content areas. This set uses the same seven areas at about half of each area's official count, rounded to whole questions.

This practice set compared with the official CPMA content-area question counts
Content area Official CPMA questions This practice set
Medical record standards and documentation guidelines 17 8
Compliance and regulatory guidelines 21 10
Coding and reimbursement concepts 13 7
Scope and statistical sampling methodologies 7 4
Quality assurance and risk analysis 2 1
Communication of results and findings 4 2
Medical record auditing abstraction 36 18
Total 100 50

Official counts: AAPC, Taking the CPMA exam, "Breakdown of the 100-question CPMA exam."

AAPC lists the case specialties as E/M, surgery, physical therapy, radiology, psychiatry, hematology/oncology, and infusion services. Each of the seven records here covers one of them, with two or three questions apiece. These are simplified teaching records, so treat the cases as practice in reading a record against a rule, not as a copy of exam cases.

CPMA exam facts

CPMA exam facts
Questions 100 multiple-choice questions
Time 4 hours, in one sitting
Passing score 70% overall (at least 70 correct)
Approved books AMA's CPT Professional Edition, plus any publisher's ICD-10-CM and HCPCS Level II; current or preceding-year print books, one copy of each, or eBooks provided in the exam platform
Calculator Provided online in the exam platform; physical calculators aren't allowed
Where you test Online with a live remote proctor, or at a testing center
Results Within 7–10 business days, in your AAPC account
Experience AAPC strongly suggests at least two years of coding experience

Source: AAPC, Taking the CPMA exam.

If you fail, AAPC tells you which categories scored 65% or below, which makes the area table above a useful place to start a retake plan. Some free practice sites still describe a 150-question CPMA or six content areas. AAPC's current page lists 100 questions in seven areas.

What to do next

CPMA practice test FAQ

Is this the official CPMA practice exam? No. This set is independent, and every question and record here is original.

Can I use code books on this test? Yes, and you should. The real exam is open book with the approved books listed above, so practice your lookups the way you'll do them on exam day.

What score should I aim for? There's no conversion from a practice set to an AAPC score. AAPC requires 70% overall on its own exam. Here, treat every miss as a rule to look up rather than chasing a number.

Do I need my CPC before taking the CPMA? AAPC doesn't require it, but it strongly suggests at least two years of coding experience before you sit for the CPMA. See AAPC's exam registration prerequisites.

Sources and verification

By Castleport Test Prep Editorial Team.

Last verified: October 22, 2026. We checked AAPC's published CPMA format, passing score, content breakdown, and approved-book rules. We checked each question's answer against the official source linked beneath its explanation, including CMS manuals and learning resources, NCCI policy, federal statutes and regulations, OIG guidance, the AMA's E/M guidelines, and the ICD-10-CM guidelines for the dates used. This was a source check, not a review by a certified auditor. AI-assisted tools supported drafting and editing, as described in our methodology. All patients, providers, and records are fictional.

AAPC exam rules

Statutes and regulations

CMS manuals, policy, and learning resources

HHS-OIG guidance

Coding guidelines

CPT code meanings are paraphrased. Use your own CPT Professional Edition for full descriptors.

Castleport Test Prep is an independent exam prep publisher and is not affiliated with, endorsed by, or approved by AAPC. CPMA and other exam and credential names identify their subjects; trademarks belong to their respective owners. These practice questions and audit records are original and unofficial, not AAPC exam questions. This practice test doesn't guarantee an exam result.

Free CPMA Practice Test: 50 Questions + Audit Cases