A child is covered by the plans of both married parents, and the parents share one birthday. Under a state coordination of benefits rule, which plan is primary?Washington Administrative Code 284-51-255, Rules for coordination of benefits. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 4.
A child is covered by the plans of both married parents. The mother was born on March 9, 1985 and the father on November 2, 1982. Under the birthday rule, whose plan is primary?Washington Administrative Code 284-51-255, Rules for coordination of benefits. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 3.
A patient asks what happens once the out-of-pocket maximum is reached for the plan year. What does the plan then pay for covered in-network care?HealthCare.gov Glossary, Out-of-pocket maximum/limit. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 7.
A patient has met the deductible. The plan's allowed amount for the visit is $180 and the coinsurance is 20%. How much is collected from the patient?HealthCare.gov Glossary, Coinsurance. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 6.
Show all 50 questions (46 more)
Medical benefits and eligibility, continued
A patient in an HMO sees a specialist without a referral from the primary care doctor. What may the plan do?HealthCare.gov Glossary, Referral. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 2.
A patient with Medicare is treated for an injury covered by a workers' compensation claim. Who pays first for that treatment?Medicare.gov, Who pays first. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 4.
An eligibility check shows a patient has Medicare Part A only. Which part, missing here, helps cover a visit to a doctor's office?Medicare.gov, Parts of Medicare. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 1.
What does a payer decide when it gives preauthorization for a service?HealthCare.gov Glossary, Preauthorization. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 1, task 5.
Medical coding: ICD 6
A code needs a 7th character but has fewer than six characters. What fills the empty positions?ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (CMS and the National Center for Health Statistics). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 A, task 3.
A patient is seen for a condition that is the sequela, or late effect, of an earlier injury. Two codes are generally needed. Which is sequenced first?ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (CMS and the National Center for Health Statistics). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 A, task 2.
An Excludes1 note sits under a code. What does it tell the coder about the excluded code?ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (CMS and the National Center for Health Statistics). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 A, task 3.
An outpatient note reads "probable pneumonia" after a visit for cough and fever. What is coded?ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (CMS and the National Center for Health Statistics). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 A, task 4.
For an office visit, which diagnosis code is listed first?ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (CMS and the National Center for Health Statistics). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 A, task 2.
In which order do the Official Guidelines have a coder look up an ICD-10-CM code?ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026 (CMS and the National Center for Health Statistics). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 A, task 1.
Medical coding: CPT 6
A patient last saw the physician, or any physician of the same specialty in the group, four years ago. For choosing an office visit code, how does Medicare class the patient?CMS, Medicare Claims Processing Manual, Chapter 12, Physicians/Nonphysician Practitioners, section 30.6.7. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 B, task 3.
Both codes of an NCCI procedure-to-procedure edit pair are billed for one patient on one date, with no modifier. What happens?CMS, Medicare NCCI Procedure to Procedure (PTP) Edits. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 B, task 4.
How does CMS describe the make-up of a CPT code?CMS, Healthcare Common Procedure Coding System (HCPCS). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 B, task 1.
Medicare pays a major procedure as a global surgical package. How many days does the whole global period run?CMS, MLN Booklet Global Surgery (MLN907166). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 B, task 3.
What is a Medically Unlikely Edit (MUE) for a procedure code?CMS, Medicare NCCI Medically Unlikely Edits (MUEs). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 B, task 2.
Which body maintains and distributes the CPT code set, by the HIPAA code set regulation?45 CFR 162.1002, Medical data code sets, read on ecfr.gov. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 B, task 3.
Medical coding: HCPCS 3
A mandatory Advance Beneficiary Notice was issued for a service and is kept on file. Which HCPCS modifier is reported on the claim line?CMS, MLN Booklet Medicare Advance Written Notices of Non-coverage (MLN006266, May 2025), Table 2. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 C, task 4.
How is a HCPCS Level II code made up?CMS, Healthcare Common Procedure Coding System (HCPCS). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 C, task 1.
Which of these does HCPCS Level II exist to identify?CMS, Healthcare Common Procedure Coding System (HCPCS). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 2 C, task 3.
Medical claims submission 12
A patient has both Medicare and Medicaid. For a service Medicare covers, which is billed first?Medicare.gov, Who pays first. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 4.
A patient in an Exclusive Provider Organization (EPO) plan has a routine visit with a doctor outside the plan's network. How does the plan treat the claim?HealthCare.gov Glossary, Exclusive Provider Organization (EPO) Plan. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 3.
A payer pays only for "medically necessary" services. Besides being needed to diagnose or treat a condition, what must such a service do?HealthCare.gov Glossary, Medically necessary. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 1.
A provider who does not accept assignment can, in many cases, charge no more than 15% above the Medicare-approved amount for non-participating providers. What is that cap called?Medicare.gov, Does your provider accept Medicare as full payment?. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 9.
An employee of a private company is hurt on the job. Which body does the Department of Labor point to for the workers' compensation claim?U.S. Department of Labor, Workers' Compensation. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 5.
How long after the date of service does a provider have to file a Medicare fee-for-service claim?42 CFR 424.44(a), read on ecfr.gov. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 4.
How many diagnosis codes can item 21 of the CMS-1500 hold?CMS, Medicare Claims Processing Manual, Chapter 26, Completing and Processing Form CMS-1500 Data Set, section 10.4. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 7.
In which item of the CMS-1500 is the NPI of the billing provider or group entered?CMS, Medicare Claims Processing Manual, Chapter 26, Completing and Processing Form CMS-1500 Data Set, section 10.4. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 7.
One service was performed on a line of the CMS-1500. What is entered in item 24G (days or units)?CMS, Medicare Claims Processing Manual, Chapter 26, Completing and Processing Form CMS-1500 Data Set, section 10.4. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 6.
What does item 24E of the CMS-1500 hold for each service line?CMS, Medicare Claims Processing Manual, Chapter 26, Completing and Processing Form CMS-1500 Data Set, section 10.4. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 7.
Which plan type lets a member use providers outside the network for an additional cost?HealthCare.gov Glossary, Preferred Provider Organization (PPO). Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 3.
Which program covers the spouse or dependent of a Veteran who meets certain service-connected disability requirements?U.S. Department of Veterans Affairs, CHAMPVA benefits. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 3, task 4.
Payments and collection management 7
A commercial health plan refuses to pay a claim. What right does the HealthCare.gov glossary describe?HealthCare.gov Glossary, Appeal. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 3.
A patient in Original Medicare has paid the Part B deductible. The provider accepts assignment and the approved amount is $90. What is the patient's usual share?Medicare.gov, Costs. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 6.
A payer's statement shows an "allowed amount" for a service. What is it?HealthCare.gov Glossary, Allowed amount. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 1.
A practice finds that Medicare overpaid it. By the regulation, when must the overpayment be reported and returned?42 CFR 401.305(b), read on ecfr.gov. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 4.
A preferred provider charges $150 for a covered service. The plan's allowed amount is $110. When the payment is posted, what happens to the $40 difference?HealthCare.gov Glossary, Balance billing. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 2.
Medicare denies a claim. Counting from receipt of the initial determination, how long does the practice have to ask for a redetermination, the first level of appeal?CMS, First Level of Appeal: Redetermination by a Medicare Contractor. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 3.
What does "accounts receivable" mean on a practice's books?Wex legal dictionary, Legal Information Institute (Cornell Law School), accounts receivable. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 4, task 5.
Law and ethics 8
A biller reports that the practice bills Medicare for visits that never took place. Which provision of the civil False Claims Act lets a private person sue on behalf of the United States?HHS Office of Inspector General, Fraud and Abuse Laws. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 2.
A breach of unsecured protected health information affects more than 500 residents of one state. Besides the individuals and HHS, who must be notified?HHS Office for Civil Rights, Breach Notification Rule. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 4.
A collection agency first contacts a patient about an unpaid balance and gives no details of the debt. Within how many days of that first contact must it give the "validation information"?Federal Trade Commission, Debt Collection FAQs. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 5.
A practice lets patients pay a balance over time by written agreement, with no finance charge. Above how many installments does Regulation Z (Truth in Lending) treat the practice as a creditor?12 CFR 1026.2(a)(17), Regulation Z (Truth in Lending), read on ecfr.gov. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 5.
How does the Stark law differ from the Anti-Kickback Statute on intent?HHS Office of Inspector General, Fraud and Abuse Laws. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 3.
To which disclosure does the HIPAA minimum necessary standard not apply?HHS Office for Civil Rights, Minimum Necessary Requirement. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 4.
Under the Anti-Kickback Statute, what counts as "remuneration"?HHS Office of Inspector General, Fraud and Abuse Laws. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 3.
Under the civil False Claims Act, what does "knowing" include besides actual knowledge?HHS Office of Inspector General, Fraud and Abuse Laws. Outline: NCCT NCICS Detailed Test Plan (effective January 2025), category 5, task 1.
How this list was compiled: Our own questions, written to the NCICS Detailed Test Plan of the National Center for Competency Testing (https://www.ncctinc.com/Documents/NCICS_2025.pdf, effective January 2025, read 2026-10-11): 100 scored items in five content categories (16, 30, 23, 15 and 16; the coding category is ICD 11, CPT 12 and HCPCS 7). The bank holds 50 questions in the same shares: 8, 15 (6, 6 and 3), 12, 7 and 8. Every fact was read on 2026-10-11 in the public source the question names: the ICD-10-CM Official Guidelines for Coding and Reporting for FY 2026, pages and manuals of CMS (the HCPCS and NCCI pages, the Medicare Claims Processing Manual, chapters 12 and 26, and two MLN booklets), Medicare.gov, the HealthCare.gov glossary, the HHS Office of Inspector General and Office for Civil Rights, the Federal Trade Commission, the Department of Labor, the Department of Veterans Affairs, federal regulations on ecfr.gov (12 CFR 1026.2; 42 CFR 401.305 and 424.44; 45 CFR 162.1002), the Washington Administrative Code and the Wex legal dictionary of Cornell Law School. Licence: Questions, choices and explanations are original work of this site.
How it works
This NCCT practice test for billing and coding has 50 questions of our own for the Insurance and Coding Specialist (NCICS) exam. It is unofficial, not affiliated with, endorsed by or sponsored by the National Center for Competency Testing (NCCT).
Read the full guide
What the exam covers
The questions follow the NCICS Detailed Test Plan (effective January 2025), read October 11, 2026. Of 100 scored questions, 16 are medical benefits and eligibility, 30 medical coding, 23 claims submission, 15 payments and collection management, and 16 law and ethics. This bank holds 8, 15, 12, 7 and 8.
Timing
Exam mode asks all 50 questions in 72 minutes, the pace of the real exam.
Where the answers come from
Each answer names the public page it was read in: the ICD-10-CM Official Guidelines for FY 2026, the Medicare Claims Processing Manual and other CMS pages, the HealthCare.gov glossary and the fraud and abuse pages of the HHS Inspector General among them.
Coding is 30 of the 100 scored questions: ICD 11, CPT 12 and HCPCS 7. Claims submission, at 23, is the next largest category.
Questions and answers
Is this NCCT's own billing and coding practice test?
No. NCCT has its own practice exam among its exam prep materials. The 50 questions on this page were written here from the public test plan, and none is taken from an NCCT exam or product.
Which NCCT exam is for billing and coding?
The National Certified Insurance and Coding Specialist exam, NCICS. NCCT's page describes the job as medical billing and coding for physician offices: preparing and submitting claims to insurance companies and sending statements to patients.
What score passes the NCCT billing and coding exam?
A scaled score of 575, on a scale from 200 to 720, by the NCCT Candidate Handbook revised January 2026. The same level of performance is asked on every form of the exam, so a count of questions right here does not forecast it.
Does this practice test print CPT codes?
No. CPT belongs to the American Medical Association, so the CPT questions here ask about rules that CMS publishes: new and established patients, global surgery periods and NCCI edits. The ICD-10-CM and HCPCS questions rest on public files of CMS.