Certified Outpatient Coder (COC) - Certification Exam

Outpatient ambulatory coder jobs are trending faster than ever before. As physicians move away from private practices and join hospital groups, career opportunities in outpatient facilities, such as ambulatory surgical centers (ASCs) or hospital outpatient billing and coding departments, are opening for coders. The Certified Outpatient Coder (COC™), formerly CPC-H®, exam validates your specialized payment knowledge needed for these jobs in addition to your CPT®, ICD-10, and HCPCS Level II coding skills. Invest in your future with the COC medical coding credential.

How Much Does a COC Earn?

Because outpatient coders have special requirements for reporting facility services and help to sustain the revenue cycle, they earn a good living. While the average annual salary for medical coding professionals is $54,980, COCs average $65,028 annually, making this credential one of the highest paying certifications. If you're thinking about becoming a certified outpatient coder, you can learn more about the average COC salary in your area with our salary calculator.

Obtaining a COC credential shows you have:

  • Proficiency in assigning accurate medical codes for diagnoses, procedures and services performed in the outpatient setting (emergency department visits, outpatient clinic visits, same day surgeries, diagnostic testing (radiology and laboratory), and outpatient therapies (physical therapy, occupational therapy, speech therapy, and chemotherapy)
  • Proficiency across a wide range of services, including evaluation and management, anesthesia, surgical services, radiology, pathology, and medicine
  • Knowledge of coding rules and regulations along with proficiency on issues regarding medical coding, compliance, and reimbursement under outpatient grouping systems. COCs can better handle issues such as medical necessity, claims denials, bundling issues, and charge capture.
  • The ability to integrate coding and reimbursement rule changes in a timely manner to include updating the charge description master (CDM), fee updates, and the field locators (FL) on the UB04
  • Correctly completing a CMS 1500 for ASC services and UB04 for outpatient services, including applying appropriate modifiers
  • Knowledge of anatomy, physiology, and medical terminology commensurate with ability to correctly code provider services and diagnoses
  • A working knowledge in assigning ICD-10-CM codes from Volumes 1 and 2


ICD-10-PCS and DRG code assignment (inpatient coding) are not tested during the COC exam.

The COC Exam

  • 150 multiple choice questions (proctored)
  • 5 hours and 40 minutes to finish the exam
  • One free retake
  • $399 ($325 AAPC Students) - one free retake
  • Open code book (manuals)

The COC (formerly CPC-H®) examination consists of questions regarding the correct application of CPT®, HCPCS Level II procedure and supply codes and ICD-10-CM diagnosis codes used for coding and billing outpatient facility/hospital and freestanding ASC services to insurance companies.

The COC exam thoroughly covers:

  • 10 questions
  • Medical terminology for all systems in the human body
  • 10 questions
  • Anatomy for all systems in the human body
  • 5 questions
  • ICD-10-CM Official Guidelines for Coding and Reporting
  • CPT® coding guidelines and parenthetical notes
  • Modifier use
  • 20 questions
  • Services covered by Medicare Parts A, B, C, and D
  • Medicare as a secondary payer
  • Requirements for completion of UB04 claim form
  • Requirements for completion of CMS 1500 claim form
  • OPPS Payment Methodology
    • APCs
    • Revenue codes
    • Status Indicators
    • Payment Indicators
    • Condition codes
    • Calculation of proper payments (excerpts from Addendum B and Addendum AA are provided on the exam)
  • IPPS Payment Methodology
    • Elements needed to determine MS-DRGs
    • Code sets required for inpatient claims
    • Reimbursement for teaching hospital setting
    • Charge masters
  • 5 questions
  • NCDs/LCDs
  • ABNs
  • 30 questions
  • ICD-10-CM Official Guidelines for Coding and Reporting
  • Diagnoses for all the chapters included in ICD-10-CM
  • Diagnosis questions will also appear in other sections of the exam from the CPT® categories
  • 20 questions
  • Evaluation and Management
    • Emergency Department
    • Outpatient Clinics
    • Observation
    • Critical Care
  • Surgery
    • Procedures approved for outpatient hospital facilities
    • Procedures approved for ASC facilities
  • Radiology
    • Diagnostic Radiology
    • Diagnostic Ultrasound
    • Radiologic Guidance
    • Mammography
    • Bone and Joint Studies
    • Radiation Oncology
    • Nuclear Medicine
  • Laboratory/Pathology
    • Organ and Disease Panels
    • Drug Testing
    • Therapeutic Drug Assays
    • Evocation/Supression Testing
    • Consultations
    • Urinalysis
    • Molecular Pathology
    • MAAA
    • Chemistry
    • Hematology and Coagulation
    • Immunology
    • Transfusions
    • Microbiology
    • Anatomic Pathology
    • Cytopathology
    • Cytogenetic Studies
    • Surgical Pathology
    • In vivo and Reproductive
  • Medicine
    • Immunizations
    • Psychiatry
    • Dialysis
    • Gastroenterology
    • Ophthalmology
    • Otorhinolaryngology
    • Cardiovascular
    • Noninvasive Vascular Studies
    • Pulmonary
    • Neurology
    • Central Nervous System Assessments
    • Hydration
    • Therapeutic and Diagnostic Administration
    • Chemotherapy Administration
    • Physical Medicine and Rehabilitation
    • Patient Education and Training
    • Non-Face-to-Face Nonphysician Services
    • Moderate Sedation
  • 10 questions
  • Modifiers
  • Supplies
  • Medications
  • Procedures performed on Medicare patients
  • 40 questions
  • Procedures approved for outpatient hospital facilities
  • Procedures approved for ASC facilities

Approved Manuals for Use During Examination

  • CPT® Books (AMA standard or professional edition ONLY). No other publisher is allowed.
  • Your choice of ICD-10-CM.
  • Your choice of HCPCS Level II.
Exam Bundle includes all code books students will need for nearly all AAPC exams*, including AAPC’s Certified Professional Coder (CPC) exam. Included are the AMA CPT® Professional, ICD-10-CM Expert, and HCPCS Level II Expert medical coding books.

Exam Book Bundle 2021 (CPT®, HCPCS, ICD-10-CM)

ICD-10-CM Code Book 2021 - Now Shipping
AMA CPT® Professional 2021 - Now Shipping
HCPCS Level II Expert 2021 - Now Shipping
Retail: $359.99   Save: $130.00 (36%)
Non-Member: $259.99
Member: $229.99


Electronic devices with an on/off switch (cell phones, smart phones, tablets, etc.) are not allowed into the examination room. Failure to comply with this policy may result in disqualification of your exam.

Any officially published errata for these manuals may also be used. No other manuals are allowed. Each code set is updated annually; it is essential that examinees use the current calendar year's coding manuals when taking the certification exam. Questions on the CPC, CPC-P and COC tests do not require the use of any other outside material.

Individuals with a solid understanding of coding fundamentals, anatomy and terminology should be able to answer each examination question through application of the CPT®, ICD-10-CM or HCPCS Level II manuals or through careful reasoning.

Approved Exam Manuals

Non-Approved Manuals for Use During Examination

Due to the advantages of additional information and/or ease of use, the following books cannot be used during the exam:

  • Any Procedural Coding Expert
  • Any Procedural Professional
  • CPT® Plus! - PMIC
  • CPT® Insider's View - AMA
  • ICD-10-CM Easy Coder
  • Study Guides

Medical Coding Certification Requirements

  • We recommend having an associate’s degree.
  • Pay examination fee at the time of application submission.
  • Maintain current membership with the AAPC.
    • New members must submit membership payment with examination application.
    • Renewing members must have a current membership at the time of submission and when exam results are released.

A COC (formerly CPC-H) must have at least two years medical coding experience (member's with an apprentice designation are not required to have two years medical coding experience.) Membership is required to be renewed annually and 36 Continuing Education Units (CEU's) must be submitted every two years for verification and authentication of expertise.


Each examination is separate and distinct from one another. To obtain all certifications, each examination must be taken separately and passed.

An overall score of 70% or higher is required to pass an exam. For examinees who do not pass, only the areas of study/categories with a score of 65% or less are provided for examinees’ preparation.

The areas of study reported reflect scores based on the number of questions in each category/section of the exam; each of the category/section may vary in the number of questions asked.

Continuing Education Unit (CEU) submissions are required for all certifications. For CEU requirements please see our CEU Information page.

Due to the level of expertise required of medical coders, AAPC expects certified coders to be able to perform not only in an exam setting but also in the real world. In addition to passing the certification exam, coders will also be required to demonstrate on-the-job coding experience. Those who pass the CPC, COC (formerly CPC-H) and/or CPC-P exams but have not yet met this requirement will be designated as an Apprentice (CPC-A, CPC-H-A and/or CPC-P-A) on their certificate.

CPC-A, COC-A (formerly CPC-H-A), or CPC-P-A Status: Members with an Apprentice designation are still required to submit annual CEUs while completing the coding job requirement.

Requirements for Removal of Apprentice Designation:

To remove your apprentice designation via on-the-job experience, you must obtain and submit two letters of recommendation verifying at least two years of on-the-job experience (externships accepted) using the CPT®, ICD-10-CM, or HCPCS Level II code sets. One letter must be on letterhead from your employer*, the other may be from a co-worker. Experience includes time coding for a previous employer and prior to certification. Both letters are required to be signed and will need to outline your coding experience and amount of time in that capacity. Download our Apprentice Removal Template for easier submission. Letterhead and signatures are still required when using this template.


Submit proof showing completion of at least 80 contact hours of a coding preparation course (not CEUs) AND one letter, on letterhead, signed from your employer verifying one year of on-the-job experience (externships accepted) using the CPT®, ICD-10-CM, or HCPCS Level II code sets.

Send proof of education in the form of a letter from an instructor on school letterhead stating you have completed 80 or more contact hours, a certificate/diploma stating at least 80 contact hours, or an unofficial school transcript.

Proof of education or experience isn’t necessary to sit for the exam. It should only be submitted (via fax or as a scanned attachment to an email) once ALL apprentice removal requirements have been met.

Please allow 2-4 weeks for processing.

* Employers can only verify time spent coding with their organization. Proof of experience letters may be from previous employers, current employers, or a combination of both.

2233 S Presidents Dr., Suite F
Salt Lake City, UT 84120

Phone: 800-626-2633
Fax: 801-236-2258
Email: apprenticeremovals@aapc.com

Have a Question? Call 877-290-0440 or have a career counselor call you.

* Medical Coding Salary

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