Medical Billing and Coding License Requirements

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In order to get a medical coding certifications, you should meet any requirements before taking the exams. Of course, each organization which offers the medical billing and coding certifications will provide different requirements. Sure, you’ll have a right to choose the organizations which have the easy-fulfilled requirements.

Knowing the organizations which offer the medical billing and coding certification is a must for you. However, you can easily choose and meet the requirements that the organizations provide. Thankfully, this post will show you a plenty of requirements for medical billing and coding certifications which organizations offer. Here you go!

Medical Billing and Coding License Requirements1

Medical Billing Certification

There are at least two organizations which offer medical billing certification, they are:

  • American Academy of Professional Coders (AAPC)

AAPC recently launched its new medical billing credential – the Certified Professional Biller (CPB) that is nationally recognized. The credential here is separate from a certified coding credential, however, it teaches some coding basics. A bonus of this new certification is that it also qualifies for college credits for the students who attend the University of Phoenix.

The AAPC course for medical billing specialists is a total of 80 hours which can be completed at the student’s pace within a four-month period or even less. Student’s enrollment begins from the date of purchase and they can login whenever they want to begin.

Moreover, the AAPC recommends the students to take courses in anatomy, medical terminology, physiology in advance of signing up for the course so that they will have better comprehension of course materials. AAPC’s requirements are that the student should complete a minimum of one module per week to stay on schedule. Additionally, the AAPC also requires the students to send email course-related questions to professional coaching staff.

The medical billing certification credential that you can take through the AAPC organization is The Certified Professional Coder (CPC) Exam. However, the CPC Exam is the conclusive step to earn CPC certification which is authorized throughout the world of healthcare as the gold standard for physician-based medical coding. The CPC exam consists of 150 multiple-choice questions which assess 17 areas of knowledge.


Continuing education is required to get the CPC. In other words, CPCs should complete at least 36 hours of approved Continuing Education Units (CEUs) every two years. CEUs are probably obtained by attending online courses, conferences, or other approved events.

  • American Medical Billing Association (AMBA)

Similar to AAPC, the annual membership renewal will be required to maintain certification. In this case, the members should renew annually to keep CMRS credentials. Members who have been certified are required to post 15 Continuing Education Units (CEUs) to AMBA.

Then, AMBA will require that 50% of the required annual CEUs come from any combination of AMBA training, courses and the annual conference, local chapter meetings and from the pre-approved CEU list.

Unlike AAPC, AMBA does not have any requirements in order to take the CMRS Exam. AMBA only recommends against sitting for the certification exam without any prior billing or coding training of some type.

Medical Coding Certifications  

There are three organizations which offer the medical coding certifications, here are they:

  • American Health Information Management Association (AHIMA)

AHIMA offers various medical coding certifications including the Certified Coding Associate (CCA), Certified Coding Specialist – Physician-based (CCS-P) and Certified Coding Specialist (CCS).

The only requirement for the CCA exam is a high school diploma or an equivalent educational background. In order to pass the exam, AHIMA really recommends you to have at least six months of experience applying coding at a healthcare organization, have completed another formal coding training and have attended an AHIMA-approved coding certificate program.

  • American Academy of Professional Coders (AAPC)

If you want to get a medical coding certificate through the AAPC, this organization will require the membership and examination fee. In this case, the AAPC recommends participants first earn an associate degree. Somehow, you have at least two years of medical coding experience, so you will be designated as an apprentice after passing the exam.

After you have completed the required two years, AAPC will remove this designation as well.

  • Board of Medical Specialty Coding and Compliance (BMSC)

BMSC offers the following coding credentials:

  • Specialty Coding Professional (SCP)
  • Advanced Coding Specialist (ACS)
  • Home Care Coding Specialist ñ Diagnosis (HCS-D)

The only requirements for getting the medical coding certification through BMSC are a high school diploma or equivalent educational background and a registration fee including the cost of the exam. In this case, this organization notes that its most successful candidates will have had at least three years of coding experience in their specialty  or two years in home-care coding.

Other Credentials for Medical Coding Certifications

  1. Certified Outpatient Coder (COC™) – Certification Exam

Certified Outpatient Coder (COC™) exam bridges the career opportunities for medical billing and coding specialists in outpatient facilities such as hospital outpatient billing and coding departments and ambulatory surgical centers (ASCs).


In order to maintain certification, COC should earn 12 CEUs annually and submit proof of completion to PMI.

  1. Certified Inpatient Coder (CIC™)

Certified Inpatient Coder (CIC™) is the new inpatient medical coding certification standard as the only credential which is dedicated exclusively to inpatient hospital/facility coding. However, the CIC will validate expert level knowledge and experience in abstracting information from the medical record for ICD-10-PCS and ICD-10-CM coding.


In order to maintain certification, CICs should earn 12 CEUs annually and submit proof of completion to PMI.

  1. Certified Risk Adjustment Coder (CRC™) – Certification Exam

The medical billing and coding specialist who already has a Certified Risk Adjustment Coder (CRC™)  basically knows how to read a medical chart and assign the correct diagnosis (ICD-10-CM) codes for a variety of clinical cases and services for risk adjustment models, such U.S. Department of Health and Human Services (HHS), Chronic Illness & Disability Payment System (CDPS), and hierarchical condition categories (HCCs).


In order to maintain certification, CRCs should  earn 12 CEUs annually and submit proof of completion to PMI.

  1. Specialty Medical Coding Certification

Speciality exams accurately measure preparedness for real world coding by being operative or patient-note based. Aside from the questions which are regarding the correct application of ICD-10-CM, HCPCS Level II, CPT®, and modifier coding assignments, the exam participant will also be tested on specialty-specific coding and regulations.

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