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2026 CBCS EXAM PREP
2026 200+ CBCS EXAM STUDY GUIDE
| Question | Answer |
|---|---|
| 2026 NHA CBCS EXAM STUDY GUIDE | |
| Codes used for durable medical equipment use in home | E Codes |
| The reason the patient came to see the physician. | Chief Complaint (CC) |
| Consists of patient's personal experiences with illnesses, surgeries, and injuries; Information of illnesses predominant in family; Patients educational background, occupation, marital status and other factors | Past, Family and Social History (PFSH) |
| Used for procedures that are always performed during the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately. | Add on Codes |
| What act mandated the reporting of ICD-9-CM diagnosis codes? | The Medicare Catastrophic Coverage Act of 1988 |
| Transmitting electronic medical insurance claims from providers to payers using the necessary infor mation systems is called | Electronic Data interchange (EDI) |
| Standards of conduct based on moral principals. Acting within ethical behav ior boundries means carry ing out one's responsibil ities with integrity, decen cy, respect, honesty, com petence, fairness and trust. | Medical Ethics |
| Three Components for E&M Codes | 1.History 2.Physical Exam 3.Medical Decision-Making |
| Where are guidelines found? | At the beginning of each section and used to provide specific coding rules for that section. |
| A fixed fee collected at the time of the patients visit. | Co-payment |
| Appropriateness of Codes, Payers rules about linkage, Documentation to support codes, Compliance with regulation and guidelines | Review Linkage Protocol |
| What is confidentiality? | Involves restricting patient information access to those with proper authorization and maintaining the security of patient information. |
| What are the names of the three tables that appear in the Index to Diseases? | Hypertension, Neoplasm, Table of Drugs and Chemicals |
| National codes for physician and non-physician service not found in the CPT Level 1 | Level 2 codes |
| A/An _____ is a person admitted to a hospital or long-term care facility (LTCF) for treatment with the expectation that the patient will remain in the hospital for a period of 24 hours or more. | Inpatient |
| HIPAA is an acronym for | Health Insurance Portability and Accountability Act of 1996. |
| Life Cycle of a Claim | Submission, Processing, Adjudication, Non-covered, Unauthorized, Medical Necessity Checks, Payment / RA / ERA |
| Codes found in the CPT manual | Level 1 codes |
| The out-of-pocket payment amount that a policyholder must meet before insurance covers the service(s) is called? | Deductible |
| A fixed percentage of covered charges applied to the patients bill after the deductible has been met. | Coinsurance |
| Covers injuries caused by insured that occurred on the insured's property. | Liability Insurance |
| "No notation of benign or malignant status is found in the diagnosis or in the patient's chart." | Unspecified |
| A writ requiring the appearance of a person at a trial or other proceeding is a _____. | subpoena |
| What is the single largest healthcare program in the United States? | Medicare |
| Used to enclose supplementary words; non-essential modifiers | Parentheses |
| A fee for service insurance that is sometimes used when a person is in between health plans, and will cover some (but not all) expenses | Indemnity insurance |
| provides Medicaid to certain groups not otherwise eligible for Medicaid. Must cover: •Pregnant women: •Children under 18: •States have option to cover: •Children up to 21: •Parents and other caretaker relatives: •Elderly: •Individuals with disabilities: | Medicaid Medically Needy |
| Used to enclose synonyms, alternative wording or an explanatory phrase | Brackets |
| Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code. | Modifiers |
| Hospital insurance provided by Medicare. Most people do not pay a premium for this coverage. | Medicare part A |
| Medical insurance to pay for medically necessary services and supplies provided by Medicare. (Doctors, outpatient care, Phys. and Occ. Therapists etc.) | Medicare part B |
| Combination of Part A and Part B. The main difference in ____ is that it is provided through private insurance companies approved by Medicare. | Medicare part C |
| Stand-alone prescription drug coverage insurance. | Medicare part D |
| A form of health insurance combining a range of coverages in a group basis. A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no deductibles | HMO Health Maintenance Organization |
| Similar to an HMO, but care is paid for as received instead of in advance in form of a schedule. PPOs may offer more flexibility by allowing for visits to out-of-network professionals. Visits within network require only the payment of a small fee. | PPO |
| A completed insurance claim form submitted with the program time limit that contains all the necessary information without deficiencies so it can be processed and paid promptly. | Clean Claim |
| A claim submitted with errors or one that requires manual processing to resolve problems or is rejected for payment. | Dirty Claim |
| Any Medicare claim that contains complete, necessary information but is illogical or incorrect (e.g., listing an incorrect provider number for a referring physician). Invalid claims re identified to the provider and may be resubmitted | Invalid Claim |
| A notice that a doctor, supplier, or provider gives a Medicare beneficiary before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment. | Advance Beneficiary Notice - (ABN) |
| An insurance claim submitted to the insurance carrier via a central processing unit (CPU), tape, diskette, direct data entry, direct wire, dial-in telephone, digital fax, or personal computer download or upload | Electronic Claim |
| Developed by the AMA and the Centers for Medicare and Medicaid Services (CMS). Used by physicians and other professionals to bill outpatient services and supplies to Tricare, Medicare, some Medicaid programs, and some private insurance/managed care plans | CMS 1500 Universal Claim Form |
| What does MAC stand for? | Medicare Administrative Contractor |
| Tracks submitted claims and dates | Claims register |
| Form generated in the office that provides the billers information necessary to get reimbursement for insurance company | Encounter form - charge ticket which contains ICD's - CPT codes |
| A failure to act when a person should | Non-feasance |
| Signing for subpoena | Front desk cannot sign subpoena the provider has to (office manager) |
| A type of referral that is requested from a facility to be dealt with within 24 hours. Requires a phone call and fax to facility | Stat referral |
| Court order to produce original records | Subpoena duces tecum |
| Tracking unpaid documents | Make file marked unpaid vendors. Check bi-weekly |
| Verifying insurance for walk-in patients | 1. Ask for demo information; 2. If schedule is available make appt today; 3. If no appt. available call triage nurse |
| Dealing with a patient who was injured while working, the front desk must get the case number assigned before the patient is seen - and the number of visits authorized | Worker's compensation cases (must have authorization before seeing patient) |
| Basic Billing Reimbursement Steps | Patient Info, Verify Ins. Prepare encounter form, Code DX & CPT, Review Linkage Protocol, Calculate physicians charges, Prepare claim, Transmit claim, Follow up on Reimbursement. |
| Who is the Payer of Last Resort? | Medicaid is always the payer of last resort. |
| 4 contributing factors for E&M Codes | New or existing patient, History, Physical Exam, Medical Decision making, Time spent can be a 5th factor |
| Three Categories for E&M Codes | • Category I: Procedures that are consistent with contemporary medical practice and are widely performed. • Category II: Supplementary tracking used for performance measures. • Category III: Temporary codes for emerging technology, services & procedures. |
| Contain full description to the procedure for a code. | Stand Alone Codes |
| A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present. | History of Present Illness (HPI) |
| Listed first in the CPT manual because they are used by all the different specialties | Evaluation and Management (E&M) codes |
| What is the table that contains a classification of sub stances for identifying poisoning states and external causes of adverse effects? | Table of Drugs and Chemicals |
| E codes are used to show | external cause of injury |
| The term "malignant" in relationship to blood pressure means | Life threatening |
| CPT publication is updated and revised | Annually |
| Largest section of the CPT book is the | Surgery section |
| Surgery section | 3 to 5 |
| CPT uses a basic __ digit system for coding services PLUS a __ digit add on modifier | 5 and 2 |
| Insurance companies go by the rule "if it is not documented, then it was not ____. | done or performed |
| Coding and billing numerous CPT codes to identify procedures that are usually Described by a single code is called | Unbundling |
| Deliberate manipulation of CPT codes for increased payment is called | upcoding |
| A term used as the name of a disease, structure, op eration, or procedure usually derived from the name of a place or person who discovered or described it first is called a/an | Eponym |
| Name 6 basic location methods to locate main terms in the index CPT | Service, procedure, anatomic site, disease, syn onym, eponym, abbrevia tion |
| Medical etiquette refers to | Consideration for others |
| AHIMA publishes | Diagnostic and procedure training code books and diagnostic coding and reporting requirements |
| Reporting incorrect information to private insurance carriers is considered | Unethical |
| Why are multi-skilled health practitioner's MSHP in demand | •They are cross trained to provide more than one function. •They are often competent in more than one discipline. •They offer more flexibility to their employer. |
| Medical ethics include | Standard of conduct |
| A self-employed medical insurance biller that does independent contracting is responsible for | Advertising, Billing, Accounting |
| When an insurance billing specialist bills for a physician and completes a Medicare claim form with information that does not reflect the true situation | he/she may be subject to fines and imprisonment |
| Billing for services or supplies not provided is | Fraud, illegal |
| A billing practice such as excessive referrals to other providers for unnecessary services is considered | Medical billing abuse |
| Stealing money that has be entrusted to one's care is known as | embezzlement |
| Coined term by AHIMA's eHealth Task Force to describe transactions in which health care information is accessed, processed, stored, and transferred using electronic chronologies is usually abbreviated as | EHIM {electronic health information management} |
| Individual designated to help a provider remain in compliance by setting policies and procedures in place, train staff regarding HIPAA, and act as the contact person for questions and complaints | •Privacy officer, •Privacy official |
| A health care coverage carrier, clearinghouse, or physician who transmits health information in electronic for in connection with transaction covered by HIPAA is called | Covered entity |
| Who renders medical services, furnishes bills, or is paid for health care in the normal course of business? | Health care provider |
| 3rd Party administrator who receives insurance claims from physician's office, performs edits, and redistributes the claims electronically to various insurance carriers? | Clearinghouse |
| Who is hired by medical practice to process claims to 3rd party payer? | Business Associate |
| List 5 disciplinary standards resulting from misconduct | verbal warning, written warning, written reprimand, suspension or probation, demotion, termination |
| Security rule that addresses electronic protected health information is divided into what 3 main sections? | 1. Administrative safeguards 2. Technical safeguards 3. Physical safeguards |
| Reasons for documentation are | Defense of a professional liability claim. Insurance carriers require accurate documentation that supports procedure and diagnostic codes |
| A diseased condition or state is known as | morbidity |
| According to birth law, if both parents have the same birthday | The hour of birth determines who pays first |
| What is the correct term to determine if a procedure is covered and medically necessary | Pre-authorization |
| Obtaining and recording patient data before the per son's first visit is known as | Pre-registration |
| Discovering the maximum $ amount that the carrier will pay for a procedure is called | predetermination |
| Criteria used by insurance companies when making decisions to limit or deny payment of medical ser vices or procedures must be justified by the patient's symptoms and diagnosis are called | medical necessity |
| If husband & wife both have insurance through their employers, and each has added the spouse to their primary insurance plans for coverage. If the wife is seen for treatment then her plan is considered | Primary |
| The Health Insurance Claim Form, also known as universal claim form is often called | CMS-1500 |
| Insurance claim submitted on paper | Paper claim |
| Insurance claim that is submitted via a dial-up modem or direct data entry | Electronic claim |
| Cost pressures on health care providers are forcing employers to reduce personnel costs by hiring | Multi skilled health care practitioners |
| Claims Assistance Professional | {CAP}- works for the consumer, helps patients file insurance claims |
| In medical practice what is "cash flow" | Actual money available to a medical practice |
| Front office medical duties have become increasingly important because | Diagnostic and procedural coding must be review for its correctness and completeness |
| What level of education is generally required for one who seeks employment as an insurance coder? | Completion of an accredited program for coding certification |
| What organization published diagnostic and procedure coding competencies for outpatient services and diagnostic coding and reporting requirement for physician billing? | {AHIMA} American Health Information Management Association |
| Amount of money an insurance billing specialist earns is dependent on what | •Knowledge •experience •Size of employing institution |
| A billing specialist is entrusted with | •Holding patients' medical information in confidence •Collecting monies •Being a reliable resource for coworkers |
| Confidentiality between the physician and the patient is automatically waived when the patient is being treated in a workers' compensation case (T/F) | True |
| A patient has the right to obtain a copy of his/her confidential health information (T/F) | True |
| Confidential information includes | •Everything that is heard about a patient •Everything that is read about a patient •Everything that is seen regarding a patient |
| Non-privileged information about a patient consists of the patient's | City of residence |
| Confidentiality is automatically waived in cases of | gunshot wound, child abuse, extremely conta gious disease |
| To bill Medicare beneficiaries at a higher rate than other patients is considered | Abuse |
| According to CLIA (Clinical Laboratory Improvement Amendments) when billing Medicare for a waived laboratory test what modifier should be used? | QW |
| What take precedence over ICD-9-CM chapter specific guidelines? | Coding conventions and instructions |
| A billing and coding specialist should understand that the financial record source that is generated by a providers office is called | a Patient Ledger Account |
| What transports oxygenated blood from the Heart | Aorta |
| How many behavior classifications are included in Table of neoplasms | 6 |
| What is the form that contains DOS (date of service), CPT codes, ICD-9-CM, fees and copayment information? | an encounter form |
| What font is the standard font for the CMS 1500 paper claim? | 10 pitch (PICA) |
| What type of insurance coverage is offered to Medicare beneficiaries by private third-party payers? | Medigap coverage |
| What is it called when an insurance claim is overdue for payment? | delinquent claim |
| What is the standard form for professional outpatient services and procedures? | CMS-1500 |
| What is a pre-existing condition? | An illness or condition present before insurance coverage begins |
| What insurance policy is NEVER primary when the insured has more than one policy? | Medicaid (payer of last resort) |
| A triangle in front of a code in the updated CPT manual means | the description of the code has been changed |
| What is the ICD-9-CM subclassification code? | 5 digits (282.60) |
| What is the ICD-9-CM subcategory code | 4 digits (255.0) |
| A document that contains dates of service (DOS), list of detail charges, co-payments & deductibles paid, date insurance was filed, adjustments and account balance is called | an Itemized statement |
| Under the RBRVS (Resource-based relative value scale) method of reimbursement, "conversion factor" is | a dollar amount |
| A service that is rarely provided, unusual, variable, or new may require a _____ in determining medical appropriateness of the service | Special report |
| Category I CPT codes | Standard medical procedures and services |
| Category II codes | Performance measurement and quality tracking codes |
| Category III codes | Emerging technology, services, and procedures (temporary codes) |
| Circle with line through it | represents modifier 51 exempt code |
| Circle with a dot in center (bulls-eye) means | moderate sedation |
| Brackets [] means | enclose synonyms, alternative wording or explanatory phrases/found in the tabular list (volume 1) |
| parentheses () means | used in both the index and tabular to enclose supplementary words. (nonessential modifiers) that may be present or absent in the statement of a disease or procedure without effecting the code number to which it is assigned |
| colon : means | located in tabular list after an incomplete term that needs one or more of the modifiers that follow in order to make the condition assignable to a given category |
| Six sections of the CPT manual are | Evaluation & Management (E&M); Anesthesia; Surgery; Radiology; Pathology; Medicine |
| Evaluation & Management (E&M) are numbered | 99201-99499 |
| Anesthesia is numbered | 00100-01999 |
| Surgery is numbered | 10021-19499 |
| Radiology is numbered | 70010-79999 |
| Medicine is numbered | 90281-99607 |
| Where are Modifiers found in the CPT book? | Front cover and Appendix A |
| What modifier is used for "unrelated evaluation & management (E/M) services by the same physician or other qualified healthcare professional during a post operative period"? | Modifier 24 |
| What modifier is used for "significant, separately identifiable evaluation & management (E&M) service by the same physician or other qualified healthcare professional on the same day of the procedure or other service"? | Modifier 25 |
| What modifier is for the "professional component"? | Modifier 26 |
| What modifier is for "bilateral procedure"? | Modifier 50 |
| What modifier is for "multiple procedures"? | Modifier 51 |
| What modifier is use for "decision made for surgery"? | Modifier 57 |
| What modifier is for "unplanned return to the operating/procedure room by the same physician following the initial procedure for a relative procedure during the post operative period"? | Modifier 78 |
| What modifier is for "unrelated procedure or service by the same physician during the post-operative period"? | Modifier 79 |
| Types of Government health insurance include | Medicare (A,B,C,D), Medicaid (categorically needy, medically needy), Tricare (Standard, Extra, Prime), CHAMPVA |
| Types of private health insurance include | Private payers/commercial carriers, Group Health Plans, Indemnity Insurance, HMO (Health Maintenance Organization), PPO (Preferred Provider Option), Point of Service, Disability, Workers Compensation. |
| A type of policy designed to supplement coverage under a fee for service Medicare plan. May cover prescription costs and the deductible & co-payment (20% of the Medicare allowed amount) | Medigap (MG)/Medifill |
| Tricare Health Insurance is | Military insurance that covers uniformed military members and their families |
| Tricare PRIME | HMO type of plan that receive healthcare through military facilities such as VA clinic and or Hospitals |
| CHAMPVA | healthcare plan for military, where the VA share costs of supplies and services with eligible beneficiaries |
| Private Payers/Commercial carriers | people who are responsible for securing their own health insurance |
| Group Health Plans are | insurance plans that provide insurance for a group offered by employers to all employees |
| Indemnity Insurance (fee for service) | is a fee for service when a person is between health plans. covers somethings but not everything |
| PPO (preferred provider organization) | Care is paid for as received instead of in advance |
| An ABN (Advanced Beneficiary Notice) is | a notice given by doctor or supplier to the patient when they believe Medicare will deny payment (patient will have to pay if denied) |
| Basic Billing & Reimbursement Steps are | Collect patient information, verify insurance, prepare encounter form, code diagnosis and CPT, review Linkage Protocal, Calculate physician charges, prepare claim, transmit claim, follow-up on reimbursement |
| Review Linkage Protocal is | appropriateness of codes, payers rules about the linkage, documentation to support the codes,& compliance with regulations & guidelines through HIPPA |
| Life cycle of a claim is | 1) submission 2) processing 3) adjudication 4) non-covered 5) unauthorized 6) medical necessity checks 7) payment/RA/ERA (remittance advice/electronic remittance advice) |
| E-codes are for | durable medical equipment(DME) used in home (medicare Part "C") AND Environmental, external cause of injury, poisoning, & other adverse effects as well as reactions to medications |
| Which Block(s) requires the patient's authorization to release medical information to process a claim | Block 12 (also acts as assignment of benefits for Medicare) |
| Under which circumstances should a paper claim be submitted to the Insurance carrier | A claim containing unlisted procedure codes |
| Eligibility verification is the process of | checking & confirming that a patient is covered under an insurance plan |
| What expedites the process of a phone appeal | Claim control number |
| Insurance policy that pays benefits in the event that the policyholder becomes incapable of working. | Disability Insurance |
| Workman's compensation is a job benefit that provides money and services to employees that are injured or become sick on the job. Worker's comp helps injured and sick workers to survive financially as they recover from health problems. | Workman's Comp |
| Refers to the base amount that is treated as the standard or most common charge for a particular medical service when rendered in a particular geographic area. | Usual Customary and Reasonable |
| The payment amount for each service paid under the physician fee schedule is the product of three factors; a nationally uniform relative value for service; a geographic adjustment factor (GAF); a nationally uniform conversion factor for the service. | Relative Value Payment Method |
| The schedule assigns certain values to procedures/costs based upon Total RVUs. The total consists of three components; work, practice expense, and malpractice. Medicare adjusts payment by geographic price cost index (GPCI) and pays depending on locale. | Medicare Resource Based Relative Value Unit (RVU) Payments/Components |
| "A condition that develops after, the outpatient care has been provided or during an inpatient admission." | Complication |
| "A concurrent condition that coexists with the first-listed diagnosis or principal diagnosis, has potential to affect treatment of the aforementioned diagnosis and is an active condition for which the patient is treated and/or monitored." | Comorbidity |
| The process by which the provider contacts the insurance carrier to see if the proposed procedure is covered by a specific patient's insurance policy. | Preauthorization |
| Monies or Funds that are owed to the practice for services provided | Accounts Receivable (A/R) |
| Monies being paid from the medical practice, for instance to pay for supplies, rent, utilities, payroll, etc. | Accounts Payable (A/P) |
| The explanation of payments received from the insurance company is often referred to or called the | Remittance Advice |
| Billing a patient for the difference between a higher usual fee and a lower allowed charge is called | Balance Billing |
| ____ is the national health insurance program for Americans aged 65 and older. | Medicare |
| Person who is responsible for a patients debt is called? | Guarantor |
| What does Medigap do? | Helps cover costs not reimbursed by the original Medicare plan. |
| A writ requiring the appearance of a person at a trial or other proceeding is a | subpoena |
| When does the tertiary insurance pay? | After the primary and secondary insurers. |
| National Provider Identifier (NPI) number | A unique 10-digit number assigned to providers in the U.S. to identify themselves in all HIPAA transactions. |
| What is a capitation? | A payment structure in which a health maintenance organization prepays an annual set fee per patient to a physician. |
| The charge for keeping the insurance policy in effect. | Premium |
| What simplified process was developed to enable Medicare beneficiaries to participate in mass pneumococcal pneumonia virus (PPV) and influenza virus vaccination programs offered by public health clinics? | Roster Billing |
| A person filing an appeal is called? | Claimant |
| Covers injuries caused by insured that occurred on the insured's property. | Liability Insurance |
| What act mandated the reporting of ICD-9-CM diagnosis codes | The Medicare Catastrophic Coverage Act of 1988 |
| For Inpatient coding, what do the initials CC mean? | Comorbidities and Complications |
| Insurer/Insured, Subscriber, Member, Recipient are all terms that apply to the? | Policyholder |
| A formal, written document that describes how the hospital or physician's practice ensures rules, regulations, and standards that are being followed is known as a/an _______________. | Compliance Plan |
| Physicians who enroll in managed care plans are called ______. They have contracts with Managed Care Organizations (MCO)s that stipulate their fees. | Participating Providers |
| The first listed diagnosis can also be referred to as | Principal diagnosis |
| Authorization by a policyholder that allows a payer to pay benefits directly to a provider is called? | Assignment of Benefits |
| A detailed accounting of the claims for which payment is being made by an insurance company. The _____ accompanies the payment from the insurance company. | Remittance Advice (RA) |
| Appropriateness of Codes, Payers rules about linkage, Documentation to support codes, Compliance with regulation and guidelines | Review Linkage Protocol |
| Electronic media refers to | Leased phone or dial-up phone lines the internet Transmissions that are physically moved from one location to another |
| HCPCS | created in 1978 by CMS; Used to report medical services, supplies, equipment, drugs, and other items for billing and reimbursement. |
| HCPCS original three code set levels: | Level I - CPT codes Level II - HCPCS codes Level III - Local codes (discont. 2003) |
| HCPCS Level I - CPT codes | 5 numeric digits; physician/outpatient procedures KEYWORD: PROCEDURES |
| HCPCS Level II - HCPCS codes | One letter + four numbers; Supplies, DME, drugs (other than oral methods), ambulance, prosthetics, etc. KEYWORD: SUPPLIES |
| HCPCS Level III - Local codes | created by state Medicare carriers/private payers; discontinued in 2003 KEYWORD: LOCAL |
| HCPCS Level II codes are maintained by which organization? | Centers for Medicare and Medicaid Services (CMS) |
| What does HCPCS stand for? A. Health Care Procedure Coding System B. Healthcare Common Procedure Coding System C. Hospital Coding Procedure Classification System D. Health Coding Process Classification System | B. Healthcare Common Procedure Coding System |
| What is HCPCS Level I? A. ICD-10-CM B. HCPCS national codes C. CPT codes D. Revenue codes | C. CPT codes |
| HCPCS Level II codes begin with: A. Numbers only B. Letters only C. A letter followed by numbers D. Roman numerals | C. A letter followed by numbers |
| Which code system is used for supplies, equipment, and ambulance services? A. ICD-10-CM B. CPT C. HCPCS Level II D. CDT | C. HCPCS Level II |
| Which of the following would MOST likely use an HCPCS Level II code? A. Office visit B. Wheelchair C. Physical exam D. Appendectomy | B. Wheelchair |
| Which organization maintains HCPCS Level II codes? A. AMA B. CDC C. CMS D. OSHA | C. CMS |
| Which modifier indicates the LEFT side of the body? A. RT B. LT C. TC D. 50 | B. LT |
| Which modifier means bilateral procedure? A. 25 B. 59 C. 50 D. 91 | C. 50 |
| What does Modifier TC indicate? A. Technical component B. Telemedicine component C. Total component D. Treatment completed | A. Technical component |
| What does Modifier 26 indicate? A. Bilateral procedure B. Repeat procedure C. Professional component D. Reduced services | C. Professional component |
| Which HCPCS code type commonly represents medications? A. J codes B. E codes C. A codes D. K codes | A. J codes |
| Which HCPCS code range is commonly used for durable medical equipment (DME)? A. E codes B. J codes C. G codes D. L codes | A. E codes |
| HCPCS Level II codes are primarily used for: A. Diagnoses only B. Procedures only C. Nonphysician services and supplies D. Surgical pathology only | C. Nonphysician services and supplies |
| Which code set is used for physician procedures and services? A. ICD-10-CM B. HCPCS Level I (CPT) C. DRG D. CDT | B. HCPCS Level I (CPT) |
| Which HCPCS code(s) are not paid by Medicare? A. A HCPCS codes B. S HCPCS codes C. T HCPCS codes D. Answer B and C | D. Answer B and C |
| Which CPT category contains the codes used for reimbursement of procedures and services? | Category I |
| Which CPT category is used for quality/performance measures? | Category II |
| Which CPT category contains emerging technology codes? | Category III |
| Who maintains CPT codes? | American Medical Association (AMA) |
| HCPCS Modifier TC (Technical Component) vs. CPT Modifier 26 (Professional Component) | TECHNICAL COMPONENT vs PROFESSIONAL COMPONENT; ∙ TC = Performing the test ∙ 26 = Interpreting the test; TC: Equipment, technician, and facility portion of a service. 26: Physician interpretation and report only; EX: CHEST X-RAY - TC = X-ray machine, technician, facility 26 = Physician reads and interprets the X-ray |
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