Medical billing and coding certifications

Medical billing and coding certifications qualify students as healthcare business professionals and open doors to a variety of career opportunities in the healthcare industry.

Both medical coding and billing play integral roles in the healthcare revenue cycle. Medical coders identify billable information in the clinical documentation and translate that information into standardized codes. Medical billers use those codes to bill patients and create medical claims to submit to insurance companies.

Why become a certified billing and coding specialist?

Health information technician, a profession that encompasses medical billing and all types of medical coding, ticks a lot of boxes in terms of career attributes considered important.

The value of professional certification

To be recognized as a coding and billing professional in healthcare, certification is a must. Certification positions you in the workforce as a legitimate professional. Physicians and provider organizations, such as hospitals, health systems, and surgery centers depend on certified coders and billers to maintain a healthy revenue cycle. Employers look for the AAPC credential because it represents mastery of the skills they rely on.

Passing the Certified Professional Coder (CPC)^® exam, for example, assures employers that job candidates possess:

• Expertise in assigning accurate medical codes for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers in the medical office, as well as professional-fee coding as it pertains to facility settings (e.g., inpatient hospital)

• Knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity, using modifiers appropriately, and observing bundling rules

• Proficiency across a wide range of services, including E/M, anesthesia, surgery, radiology, pathology, and medicine

• Thorough grasp of anatomy, physiology, and medical terminology to comprehend code descriptors and the patient record

• Understanding of how to integrate medical coding and payment policy changes into a practice's reimbursement processes

Nothing gives hiring managers more confidence in a coder or biller’s proficiency than passing the national certification exam — which is why employers pay certified coding and billing professionals approximately 30% more than non-certified staff. The salary gap widens with every certification added to a coding and billing professional’s resume.

Medical billing certifications

The health information technician’s ability to optimize an organization’s revenue cycle depends on a strong understanding of medical insurance, the claims process, the appeals process, and compliance regulations. The financial health of a physician practice depends on the effectiveness of the billing office.

The primary medical billing certification is the CPB, which stands for certified professional biller.

Certified Professional Biller (CPB)^®: Earning your CPB certification validates professional knowledge and skills across the medical billing and reimbursement cycle — including preauthorization, charge entry, claims transmission, submitting appeals, payment posting, insurance follow-up, and patient follow-up.

Passing the national certification exam and earning your CPB certification qualifies you to work in any healthcare setting providing insurance-sponsored medical care. This includes physician offices, ambulatory surgery centers, health systems, hospitals, rehabilitation facilities, long-term care facilities, dentist’s offices, billing companies, etc.

Medical coding certifications

Medical coding accuracy is key to optimal, ethical reimbursement, which makes certified medical coders integral to healthcare organizations providing treatment and services to patients. There are 4 core medical coding certifications to choose from, each of which focuses on a unique reimbursement system used in a defined healthcare setting.

Certified Professional Coder (CPC): The CPC credential recognizes expertise in physician-based or pro-fee coding, which encompasses the proper use of medical codes as they apply to the physician practice and provider reimbursement. Passing the CPC exam and earning your CPC certification qualifies you to work at a physician practice or medical office, a walk-in clinic, a lab, a telehealth company, a home health agency.

Dual CPC and CPB Certification: Dual certification as a CPC and CPB validates expertise in pro-fee coding, as well as proper claim form preparation, submission and payment processes, regulatory compliance, and insurance requirements.

Many people choose to launch their healthcare careers with dual certification for advantages in employability and salary negotiations. Once earning both certifications, which takes 10 – 12 months when training in an online coding and billing program, students can begin successful careers working in physician offices, outpatient facilities, and laboratories. 

Certified Outpatient Coder (COC)^®: Students who earn their COC certification are recognized by employers as possessing proficiency in coding outpatient services and procedures to government and private payers. This certification also demonstrates working knowledge of the Hospital Outpatient Prospective Payment System, as well as Ambulatory Payment Classifications (APCs).

Once certified, COCs go on to report outpatient services in a variety of healthcare settings, such as hospital emergency departments, outpatient hospital clinics, outpatient therapy departments, outpatient cancer centers, dialysis centers, outpatient radiology departments, and ambulatory surgery centers.

Certified Inpatient Coder (CIC)^®: The CIC credential recognizes expertise in inpatient facility coding, which relies on two code classification systems not used in other healthcare settings. CIC certification is critical to a career as an inpatient medical coder working in a hospital or hospital-type setting, such as a long-term care facility or rehabilitation center.

Certified Risk Adjustment Coder (CRC)^®: The CRC certification validates expertise in the complexity of diseases associated with chronic conditions and comorbidities, as well as mastery of ICD-10-CM guidelines and risk adjustment guidelines. CRCs work to ensure that the patient record accurately portrays the patient’s health status and that all clinically documented diagnoses are properly reported.

Specialty certifications in medical billing and coding

Specialty certifications enable coders to demonstrate superior levels of expertise in their respective medical fields. These specialty credentials stand alone and do not require CPC certification. However, the median salary for CPCs with an additional specialty credential rises 11%, from $58,055 per year to $64,442 annually.

Ambulatory Surgery Center Coder (CASCC)™: CASCC certification endorses superior competency in coding for services and procedures performed in an ambulatory surgery center (ASC). This competency includes the ability to navigate operative reports and to apply ASC rules for reimbursement, such as multiple, device-intensive and discontinued procedures.

Certified Anesthesia and Pain Management Coder (CANPC)^™: CANPC certification validates a medical coder’s proficiency in surgical reporting and pain management. This proficiency includes knowledge of anesthesia coding, as well as elements of anesthesia claims, such as units of time and anesthesia modifiers.

Certified Cardiology Coder (CCC)^™: CCC certification recognizes demonstrated skill reporting surgical procedures performed by cardiologists, such as heart catheterization, coronary interventions, pacemakers, peripheral vascular procedures, etc.

Certified Cardiovascular and Thoracic Surgery Coder (CCVTC)™: CCVTC certification represents excellence in reporting surgical procedures performed by cardiovascular and thoracic surgeons, such as cardiopulmonary bypass, PTCA, lung tumor ablation, etc.

Certified Emergency Department Coder (CEDC)®: CEDC certification endorses excellence in coding the myriad procedures performed by emergency department physicians, such as thoracentesis, laceration repair, moderate sedation, fracture care, foreign body removal, etc.

Certified Evaluation and Management Coder (CEMC)^®: CEMC certification validates command of evaluation and management (E/M) medical decision-making guidelines, which pertain to multiple specialties. Certified coders also can opt for the less intensive certificate program, Evaluation and Management (E/M) Online Training.

Certified Family Practice Coder (CFPC)™: CFPC certification recognizes expertise in coding general medicine/family practice services and procedures, such as venipunctures, injections, EKGs, lesion excisions, foreign body removals, fracture care, etc. This competency includes proper sequencing using RVUs when multiple procedures are performed.

Certified Gastroenterology Coder (CGIC)™: CGIC certification shows expert aptitude for coding procedures performed by gastroenterologists, such as colonoscopies, esophageal dilations, ERCP, etc.

Certified General Surgery Coder (CGSC)™: CGSC certification represents expert ability to read and dissect operative notes and apply correct ICD-10-CM, CPT®, HCPCS Level II, and modifier coding assignment when reporting general surgery procedures, such as hernia repairs, breast procedures, transplants, etc.

Certified Hematology and Oncology Coder (CHONC)™: CHONC certification validates expertise in coding of surgical procedures performed by hematologists and oncologists and auxiliary staff — including chemotherapy administration, hydration services, therapeutic, prophylactic and diagnostic administration, bone marrow aspiration, bone marrow biopsies, venipuncture, vaccinations, therapeutic phlebotomy, etc.

Certified Interventional Radiology Cardiovascular Coder (CIRCC)®: CIRCC certification validates expertise coding and charging in the complex areas of interventional radiology and cardiovascular medicine.

Certified Obstetrics Gynecology Coder (COBGC)™: COBGC certification validates coding proficiency for the spectrum of obstetric services — from antepartum care and delivery to postpartum care and surgical procedures that include hysterectomies, biopsies, colpopexies, etc.

Certified Ophthalmology Coder (COPC)®: COPC certification represents expertise in coding office and surgical procedures performed by ophthalmologists, such as retinal detachment repair, vitrectomy, and corneal transplants.

Certified Orthopedic Surgery Coder (COSC)™: COSC certification endorses proficiency in coding orthopedic procedures, including ACL reconstruction, joint, fusion, joint replacements, diskectomy, laminectomy, etc.

Certified Professional Coder in Dermatology (CPCD)®: CPCD certification represents expertise in coding surgical procedures performed by dermatologists, such as debridement, lesion excisions, flaps, Mohs micrographic surgery, etc.

Certified Pediatric Coder (CPEDC)™: CPEDC certification validates aptitude in coding services and procedures required in pediatric medicine, such as venipuncture, injections, vaccinations, vision testing, lesion excisions, foreign body removal, fracture care, etc.

Certified Rheumatology Coder (CRHC)™: CRHC certification validates coding proficiency in the medical field of rheumatology, including surgical procedures like trigger point injections, joint injections, synovial fluid analysis, viscosupplementation, etc.

Certified Urology Coder (CUC)^™: CUC certification endorses proficiency applying correct ICD-10-CM, CPT^®, HCPCS Level II, and modifier assignment when reporting urology services and procedures, such as urinalysis, cystoscopies, biopsies, prostatectomies, etc.

Billing and coding certification FAQs

What does a medical biller and coder do?

Medical billing and coding professionals are involved in the healthcare reimbursement cycle. Together, they ensure that healthcare providers are accurately and efficiently paid for the services they perform.

When a patient sees the doctor, the medical coder reviews the clinical documentation and assigns codes to represent key information, such as the patient’s symptoms and medical history, the doctor’s observations, and the services the physician rendered, as well as diagnostic tests, diagnoses, treatment plans, and treatment outcomes, etc.

The medical biller processes and follows up on claims sent to commercial or federal payers for reimbursement of services provided by the healthcare organization. A biller regularly communicates with physicians and other healthcare professionals to clarify diagnoses or to obtain additional information. The medical biller must understand how to read the medical record and be familiar with medical codes.

What is the salary for medical billing and coding jobs?

The average annual salary for a CPB is $56,652. For a CPC, which is the most recognized medical coding certification, the average annual salary is $58,055. But many factors influence salaries, such as location and billing or coding experience. If you’re interested in pursuing certification in a medical billing and coding, AAPC’s Salary Survey Report will help you assess your earning potential.

What are the benefits of earning a medical billing and coding certification?

Earning your certification comes with significant benefits. Besides a competitive salary that towers over the investment to become a coding and billing specialist, the profession ranks high for job opportunities and career advancement, as well as work-life balance and the potential to work from home. Plus, you can transition to this profitable and well-respected career in a matter of months.

Related Article: Perks of being a Medical Coder

How long does it take to become a certified medical biller and coder?

Becoming a certified medical biller and coder doesn’t require a 2-year associate degree or 4-year bachelor’s degree. Ultimately, employers look for job candidates with billing and coding certification. The path for most certified professionals begins as a recent high school graduate who enjoys healthcare and learning about medical records.

AAPC medical billing and coding online courses require 4 to 8 months for successful completion. Students typically allot a month or two after successful completion of training to study for the certification exam.

How much experience in the medical field do you need before you can learn medical billing and coding?

You don’t need prior healthcare experience to become a certified medical records technician. Your billing and/or coding certification program will teach you everything you need to know. You’ll learn about relevant code sets, billing procedures, and regulations. You’ll also learn anatomy and medical terminology so you can assign proper diagnoses and procedure codes based on what you read operative reports and patient charts. loo

Which coding certification course is right for you?

Most students choose from the four core coding certifications when starting their medical coding careers. Training programs for each of these core certifications focus on a unique reimbursement system used in a particular healthcare setting. Deciding which certification is a good fit for you depends on where you think you’d like to work — a hospital or a doctor’s office, for example.

How can you decide which specialty certifications in medical billing and coding are right for you?

First, you don’t have to specialize in a medical field unless you want to you. Choosing a medical coding and billing specialty certification boils down to preference. Consider your interests and ask yourself a couple of questions:

• Is there a particular type of medical practice you’d like to work at?

• Is there a field of medicine you find more interesting than others?

How do you choose a medical billing and coding program?

Before choosing an online program to train for medical coding and billing certification, do some research. Make sure the program covers the necessary skills required to perform well at the profession, compare costs, and look for training features you consider important. Above all, ask about their certification pass rates. You’ll want to choose a program with a high pass rate to ensure you get the education you deserve.

How much does it cost to get a medical billing and coding certification?

Colleges and universities charge between $4,200 and $19,500 for medical coding and billing studies, but you can find an online medical billing and coding certificate program for a lot less. AAPC offers inclusive training packages in the ballpark of $2000.

What are the requirements for earning a medical billing and coding certification?

To sit for the CPC, COC, CIC, or CRC certification exam, you should have a high school diploma or equivalent (GED). You should also complete an in-person or online medical billing and coding certification program. This program should equip you with working knowledge of ICD-10-CM, CPT, HCPCS Level II, and/or -PCS coding, depending on your chosen certification, as well as prerequisite courses in medical terminology, anatomy, pathophysiology,

You must then schedule your certification exam. In the weeks leading up to the exam, we recommend incorporating practice exams in your study routine. The final requirement to attaining your medical billing and coding certification is passing the exam. A minimum score of 70% is considered passing.  

Can you train for your medical billing and coding certification online?

To prepare for your medical billing and coding certification exam, you can choose in-person classroom training or online training. AAPC offers self-paced online training, as well as instructor-led online training courses.

Can I get free career counseling for medical billing and coding certification?

We’re here to answer your billing and coding certification questions! Our career counselors are available at your convenience to answer your billing and coding certification questions, lay out your certification training options, and support you on your journey in professional medical coding. Feel free to call 877-290-0440 to speak to a career counselor or have a career counselor call you.

Why enroll in an AAPC medical coding and billing certification program?

AAPC specializes in healthcare business education and has set the standards for medical coding and billing. Not only did we create the industry’s accreditations for coders and billers, but we’ve been teaching these programs for more than 30 years.

Highest certification pass rate

Our experience means first-rate training — and the proof is in our certification exam pass rates. When you train with AAPC, you’re 3 times more likely to pass your national certification exam than if you trained at any other medical billing and coding schools.

By studying with the creators of the CPB, CPC, and advanced coding certifications, you receive training with the same standard of excellence as the credentials themselves. You’re also ensured a comprehensive education that covers everything needed to pass your certification exam, earn your professional coding credential, and succeed in your rewarding career.

Career development

AAPC supports you as you work to pursue professional milestones throughout your career. Our career counselors will help you know your worth and negotiate your salary, give you advice on how to elevate your earning potential, and provide you with guidance to advance your career in the business of medicine.

Financial support

AAPC recognizes education as essential to advancing your career, and we’re committed to making your professional development affordable. We offer feasible payment plans on our certification courses, as well as financial aid.

Employment tools

AAPC provides resources to help you gain employment — including a nationwide job database, a professional network of more than 200,000 peers, local chapters, and regional and national conferences, as well as our mentorship program and our Project Xtern program.