certified professional biller (CPB) EXAM
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A |INSTANT DOWNLOAD PDF
1. Which of the following is considered the primary purpose of
medical coding?
A. To diagnose patients
B. To ensure accurate billing and reimbursement
C. To prescribe medications
D. To maintain patient confidentiality
Answer: B. To ensure accurate billing and reimbursement — Accurate
coding ensures healthcare providers are reimbursed correctly by
insurance payers.
2. What does CPT stand for in medical billing?
A. Certified Procedural Technician
B. Current Procedural Terminology
C. Clinical Patient Therapy
D. Coding Procedures Today
Answer: B. Current Procedural Terminology — CPT codes standardize
reporting of medical, surgical, and diagnostic procedures.
3. Which of the following is a requirement for HIPAA compliance in
billing?
A. Disclosing patient information freely
B. Securing patient records and PHI
C. Only billing cash patients
D. Using unencrypted emails for medical records
,Answer: B. Securing patient records and PHI — HIPAA mandates
confidentiality, integrity, and security of patient health information.
4. What is the purpose of an EOB (Explanation of Benefits)?
A. To replace a medical bill
B. To explain how a claim was processed by insurance
C. To serve as a prescription
D. To schedule appointments
Answer: B. To explain how a claim was processed by insurance — EOBs
detail coverage, patient responsibility, and adjustments made.
5. Which type of code is used to report diagnoses in billing?
A. ICD
B. CPT
C. HCPCS Level II
D. NPI
Answer: A. ICD — International Classification of Diseases codes are used
to report medical diagnoses.
6. What is a common reason a claim might be denied?
A. Correct patient information
B. Timely submission
C. Incorrect coding or missing documentation
D. Use of electronic billing
Answer: C. Incorrect coding or missing documentation — Denials often
result from coding errors or incomplete documentation.
7. What does HCPCS Level II code represent?
A. Diagnosis codes
B. Procedures performed in a hospital
C. Supplies, drugs, and non-physician services
D. CPT modifiers
, Answer: C. Supplies, drugs, and non-physician services — HCPCS Level II
codes cover items not included in CPT, like durable medical equipment.
8. Which of the following is considered patient responsibility in
billing?
A. Provider coding
B. Insurance premium
C. Co-pay, deductible, and co-insurance
D. Medical record maintenance
Answer: C. Co-pay, deductible, and co-insurance — Patients are
responsible for their cost-sharing amounts defined by the insurance
plan.
9. What is the correct definition of a “clean claim”?
A. A claim with no errors or missing information
B. A claim that is paid in full
C. A claim sent by mail
D. A claim only for cash patients
Answer: A. A claim with no errors or missing information — Clean
claims are processed quickly without rejections or denials.
10. Which modifier is used to indicate a procedure was performed
more than once?
A. 25
B. 59
C. 76
D. 50
Answer: C. 76 — Modifier 76 indicates a repeat procedure by the same
provider.
11. When should a CPT code be used in billing?
A. For patient diagnoses
B. For procedures and services performed
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A |INSTANT DOWNLOAD PDF
1. Which of the following is considered the primary purpose of
medical coding?
A. To diagnose patients
B. To ensure accurate billing and reimbursement
C. To prescribe medications
D. To maintain patient confidentiality
Answer: B. To ensure accurate billing and reimbursement — Accurate
coding ensures healthcare providers are reimbursed correctly by
insurance payers.
2. What does CPT stand for in medical billing?
A. Certified Procedural Technician
B. Current Procedural Terminology
C. Clinical Patient Therapy
D. Coding Procedures Today
Answer: B. Current Procedural Terminology — CPT codes standardize
reporting of medical, surgical, and diagnostic procedures.
3. Which of the following is a requirement for HIPAA compliance in
billing?
A. Disclosing patient information freely
B. Securing patient records and PHI
C. Only billing cash patients
D. Using unencrypted emails for medical records
,Answer: B. Securing patient records and PHI — HIPAA mandates
confidentiality, integrity, and security of patient health information.
4. What is the purpose of an EOB (Explanation of Benefits)?
A. To replace a medical bill
B. To explain how a claim was processed by insurance
C. To serve as a prescription
D. To schedule appointments
Answer: B. To explain how a claim was processed by insurance — EOBs
detail coverage, patient responsibility, and adjustments made.
5. Which type of code is used to report diagnoses in billing?
A. ICD
B. CPT
C. HCPCS Level II
D. NPI
Answer: A. ICD — International Classification of Diseases codes are used
to report medical diagnoses.
6. What is a common reason a claim might be denied?
A. Correct patient information
B. Timely submission
C. Incorrect coding or missing documentation
D. Use of electronic billing
Answer: C. Incorrect coding or missing documentation — Denials often
result from coding errors or incomplete documentation.
7. What does HCPCS Level II code represent?
A. Diagnosis codes
B. Procedures performed in a hospital
C. Supplies, drugs, and non-physician services
D. CPT modifiers
, Answer: C. Supplies, drugs, and non-physician services — HCPCS Level II
codes cover items not included in CPT, like durable medical equipment.
8. Which of the following is considered patient responsibility in
billing?
A. Provider coding
B. Insurance premium
C. Co-pay, deductible, and co-insurance
D. Medical record maintenance
Answer: C. Co-pay, deductible, and co-insurance — Patients are
responsible for their cost-sharing amounts defined by the insurance
plan.
9. What is the correct definition of a “clean claim”?
A. A claim with no errors or missing information
B. A claim that is paid in full
C. A claim sent by mail
D. A claim only for cash patients
Answer: A. A claim with no errors or missing information — Clean
claims are processed quickly without rejections or denials.
10. Which modifier is used to indicate a procedure was performed
more than once?
A. 25
B. 59
C. 76
D. 50
Answer: C. 76 — Modifier 76 indicates a repeat procedure by the same
provider.
11. When should a CPT code be used in billing?
A. For patient diagnoses
B. For procedures and services performed
