CPCA Cheat Sheet 2026

The 30 highest-yield CPCA facts, distilled from real exam questions. Print it, save it as a PDF, or study it here — free, no sign-up.

1. What does the term 'coordination of benefits' (COB) refer to in medical billing? → Determining which payer is primary when a patient has multiple coverages
2. A patient is diagnosed with atopic dermatitis of the upper limbs. Which code applies? → L20.81
3. Which word is the correct plural form of 'diagnosis'? → Diagnoses
4. Which criterion most commonly determines whether a rhinoplasty qualifies for insurance coverage rather than being classified as cosmetic? → Documented nasal obstruction causing functional breathing impairment
5. What does a 'clinical pathway' contribute to medical necessity documentation? → It provides evidence-based benchmarks that support the rationale for ordered services
6. A coder earns $22.50 per hour and works 37.5 hours per week. What is their weekly gross pay? → $843.75
7. Which of the following best describes a 'write-off' in medical billing? → The amount the provider agrees not to collect as part of a contractual agreement
8. A provider's AR balance is $85,000. They collect $12,500 in week 1 and $9,800 in week 2. What is the remaining AR balance? → $62,700
9. A hospital collects $1.2 million in revenue. If 6.5% goes to bad debt, how much is lost to bad debt? → $78,000
10. Which HCPCS code represents trastuzumab injection, 10 mg? → J9355
11. A patient is diagnosed with allergic contact dermatitis due to poison ivy. Which category applies? → L23
12. A patient has herpes zoster with associated skin eruption. Which code is sequenced first? → B02.9
13. Adjacent tissue transfer and rearrangement CPT codes (14000–14350) are selected based on: → The total area of the defect plus the flap design combined, and the anatomical location
14. When a physician uses a qualified surgical assistant during an aesthetic procedure, which modifier is typically appended to the assistant's claim? → -80
15. Which CPT code reports a primary rhinoplasty that includes major septal repair? → 30420
16. A dermatology practice submits a claim and receives a payment that is less than the billed amount with no explanation. What should the biller do first? → Request an Explanation of Benefits (EOB)
17. A brachioplasty (excision of excessive skin from the upper arm) is coded with which CPT? → 15836
18. A physician administers 10 mg of ketorolac tromethamine injection. The HCPCS code J1885 is per 15 mg. How should this be billed? → Bill 1 unit rounding up
19. Which modifier would be appended to indicate that a procedure performed during a global period was unrelated to the original surgery? → Modifier 79
20. A physician performs 3 procedures in one session: one billed at $420, one at $315, and one at $210. What is the total charge for the session? → $945
21. A cosmetic dermatology practice bills a procedure that is explicitly excluded from coverage. What is the best course of action? → Collect full payment directly from the patient before service
22. We are glad to ____ you the marketing director post after carefully examining your application. → Offer
23. Which documentation practice helps prevent a 'lack of medical necessity' audit finding for diagnostic testing? → Documenting the specific signs, symptoms, or clinical question the test is meant to answer
24. Which phrase in a physician's note WEAKENS medical necessity documentation? → 'Referred at patient request'
25. Which HCPCS code is assigned for lorazepam injection, 2 mg? → J2060
26. Which of the following HCPCS codes correctly identifies the supply of incobotulinumtoxinA, 1 unit? → J0588
27. What is the standard global surgery period for major surgical procedures under Medicare guidelines? → 90 days
28. Photodynamic therapy (PDT) using a photosensitizing agent applied to the skin is reported with which CPT code? → 96567
29. A CPCA is conducting a third-party vendor risk assessment. Which factor is most critical to evaluate when the vendor processes regulated data? → The vendor's own compliance certifications and audit reports (e.g., SOC 2, ISO 27001)
30. If a physician's note includes a plan but omits the assessment (diagnosis or clinical impression), how does this affect medical necessity documentation? → It weakens the record because the clinical rationale for the plan is missing