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2024 EDITION
Medical Biller Practice Test
Try this free medical billing practice test to see what's on a certification exam for medical billers.

Certification as a medical biller demonstrates one's knowledge and skill in the field of medical billing and can
help one get a job as a medical biller and earn more in pay. The American Academy of Professional Coders
(AAPC) provides training and credentialling for medical billers across the United States. After passing the
AAPC medical billing exam, a medical biller earns the Certified Professinal Biller (CPB) credential. The
medical biller exam must be passed to earn certificaiton. The medical billing exam has 135 multiple choice
questions and four hours is given to complete the exam.

To prepare for the AAPC CPB exam, use our 500 Question Medical Billing Practice Exam
(https://www.tests.com/Medical-Billing-Practice-Exam).
(/Medical-Billing-Practice-
For additional practice for medical coding, use our 500 Question Medical Coding Practice Exam Exam)
(https://www.tests.com/Medical-Coding-Practice-Exam).
Quality starts with who
wrote the material.
View Answers as You Go View 1 Question at a Time
Our practice exam writer s :

Mandy Colligan, is an
Types of Insurance assistant professor of Health
Information Management at
the ... more
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Carol Maimone, is an
1. Tricare is insurance for: assistant professor and
a. Active-duty military and their families program coordinator in
medical billing ... more
b. Surviving spouses of military service members.
c. Retired service members Pamela Davis, is an adjunct
instructor in medical coding
d. All of the above and billing at Trident ... more
Tricare covers active duty service members and their families
and also surviving spouses and retired active duty service
members under certain plans. Our Medical Coding
Practice Test follows the
actual exam outline of the
AAPC:

- Medical Terminology
- Anatomy
2. Betty Jane has Medicare coverage. You explain to her - Compliance and Regs
that she cannot come to see Dr. Frank at the outpatient - Coding Guidelines
clinic for a simple skin cancer removal because she: - ICD-10-CM
- HCPCS Level II
a. Only has Medicare Part A - CPT
b. Only has Medicare Part B - 10,000 Series
- 20,000 Series
c. Medicare does not cover outpatient clinics - 30,000 Series
(https://www.tests.com/Medical-Billing- - 40,000 Series
d. Her diagnosis does not meet medical necessity Practice-Exam) - 50,000 Series
Click to Save 50% Now - 60,000 Series
- Radiology Codes
3. Farah has Medigap and pays out-of-pocket for this coverage. Which of the following will this plan - Pathology Codes
- Laboratory Codes
cover? - Medicine
a. Hospital stays - E/M
- Anesthesia
b. Long-term care - Case Studies
c. Glasses
d. Dental care
Medigap only covers what original Medicare covers, but will cover deductibles, copays and coinsurance.
Medigap does not cover prescription drugs or anything else that traditional Medicare does not cover.

4. Medicaid is administered by:

a. state governments
b. federal government
c. private companies
d. nonprofit organizations
Medicaid is administered by the state governments, in accordance with federal requirements, and is for low
income, disabled or individuals with complex medical needs and has a sub-section for a children's insurance
plan in some states.

5. Which of the following is not a private insurance carrier?

a. Cigna
b. Aetna
c. United Healthcare
d. CMS
CMS is Centers for Medicare and Medicaid which is run by the government and not private insurance.

(http://www.bbb.org/washington-
6. A patient comes in with a piece of metal shavings in his eye that he got while welding at his job. dc-eastern-pa/business-
He has Anthem health insurance through his work. Which of the following insurances would cover reviews/test-publishers/tests-
his visit? com-in-lititz-pa-
a. Medicaid 235991163/#bbbonlineclick)
b. Anthem
c. Worker's compensation Find Other Tests GO
d. Disability insurance
(/#email) (/#facebook) (/#twitter) (/#pinterest)
The worker/patient must fill out a worker's compensation claim. His private insurance will not cover a work-
based injury. The insurance company will be notified because there is a specific box on the CMS-1500 form (https://www.addtoany.com/share#url=https%3A%2F%2F2.zoppoz.workers.dev%3A443%2Fhttps%2Fwww.tests
that asks whether this injury was related to work. Billing-Practice-
Test&title=Medical%20biller%20practice%20test%2C%20medical%20
%202024%20Updated)
7. The difference between an HMO and a PPO is:
a. HMOs cost less, but provide better care. Bookmark Page
b. PPO plans allow patients to be seen out of network at an increased cost, while HMOs do not.
c. HMO plans allow patients to be seen out of network at an increased cost, while PPOs do not.
d. There is no difference between HMOs and PPOs.
Medical Billing Regulations

8. The time allowed to submit a claim to Medicare is:

a. 365 days
b. 180 days
c. 120 days
d. 90 days
365 days or 1 year is timely filing for Medicare. Other insurances, such as Humana, have shorter timely filing
periods of 90 days. Claims can be submitted to Medicare after 1 year but will be denied for timely filing limit
and no payment will be received.

9. A patient has medical coverage through IHS. To which of the following organizations would you
most likely submit a claim?
a. Muscogee Nation Health System
b. Blue Cross Blue Shield
c. United Healthcare
d. Saint Marcus Health System
The Muscogee Nation Health System is part of the Indian Health Service (IHS). Patients who have IHS
coverage will have their claim often submitted directly to the tribe for payment.

10. Which act mandates the provision of emergency medical treatment in order to stabilize the patient,
even if the patient cannot pay for it?
a. ACA
b. ARRA
c. EDTA
d. EMTALA
Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to provide emergency
medical treatment to individuals regardless of their insurance status or ability to pay. It ensures that emergency
services are provided during critical situations without financial discrimination, however it only provides enough
coverage to stabilize the patient.

11. Which of the following regulations prohibits billing of invalid claims to government payers only?
a. Payment Protection Program (PPP)
b. False Claims Act (FCA)
c. Anti-Kickback Statute
d. Stark Law
The False Claims Act imposes criminal penalties for falsely submitted claims to government payers. It does not
cover commercial payers, only payers that receive money from the federal government. Penalties can be
severe and may result in millions of dollars of fines or even jail time.

12. Which of the following changes would be considered a criminal offense in medical billing?
a. Raising the price of the usual and customary fee across all payers.
b. A coder switching an E/M code from 99213 to 99214.
c. Writing off BCBS copays after three years of nonpayment.
d. Adding a modifier to a claim to a bilateral code to get both sides paid.
Bilateral codes are inherently two-sided. Adding a modifier to the code to get two bilateral codes paid for the
same procedure would be a false claim and subject to possible criminal penalties.

13. What is the main objective of the Medicare Access and CHIP Reauthorization Act (MACRA)?
a. To eliminate the use of social security numbers in Medicare.
b. To provide health insurance for children under the CHIP program.
c. To change the way Medicare rewards clinicians for value over volume.
d. To expand Medicare coverage for young children.
MACRA changes how Medicare Part B providers are paid, shifting the focus from a fee-for-service model to a
value-based care model, where providers are rewarded based on the quality and effectiveness of the care they
provide.

14. Under which law are out-of-network providers prohibited from balance billing patients for
radiology fees?
a. Administrative Simplification Act
b. Affordable Care Act
c. No Surprises Act
d. Merit-Based Incentive Payment System
The purpose of the No Surprises Act is to give protection to patients for unexpected medical bills, in particular,
out-of-network providers in emergency situations or at in-network facilities without the patient giving consent.
This act restricts excessive out-of-pocket costs to patients from surprise billing. This only applies to certain
provider types, like radiology, ambulance and laboratory.

15. The amount a provider charges the insurance company for services:
a. Varies depending on how much the insurance reimburses for that procedure
b. Must be a set amount per procedure for all insurance carriers
c. Must be a set amount for each particular insurance carrier
d. Can change depending on how complex the procedure was
A usual and customary amount (U&C) must be set and charged the same amount to all insurance carriers. The
U&C amount can change and should be set to higher than the highest paying insurance company in order to
capture complete reimbursement.

16. According to CMS, which form must be obtained and signed for Medicare beneficiaries receiving
non-covered services before those services are rendered?
a. CMS-1500
b. ABB
c. NBN
d. ABN
An advance beneficiary notice (ABN) must be filled out before a patient receives non-covered services. This
form must include a breakdown of all costs and the reason why it will not be covered. CMS-1500 is used to
submit claims and beneficiaries never see it.
17. Marge has Medicaid and goes to see the chiropractor once a week. The chiropractor takes
Medicaid but informs Marge that she has a $25 copay for each visit. Marge's insurance card lists
no copay. When questioned, the billing office tells Marge that her insurance only reimburses $17
per chiropractic visit and it would cost them more to bill her insurance than it would just to have
her pay--and it's only $25. According to Medicaid regulations:
a. It is illegal to bill Medicaid patients without signed consent.
b. it is illegal to bill Medicaid patients before billing Medicaid first.
c. Marge should call Medicaid to see if her copay has changed.
d. Marge should ask to pay $17 per visit.
It is illegal to bill Medicaid patients without signed consent. The chiropractor should refund her money and bill
her insurance properly. Even if a service is not covered when billed to Medicaid, the balance cannot be billed
to the patient afterwards.

18. A Medicare patient calls. She's been seeing Dr. Hamilton for 10 years for her chronic conditions.
It's January and her furnace just broke and it will be $500--and she's on a fixed income and just
can't swing the furnace and her Medicare deductible right now. She's going to have to make
payments on the furnace as it is. She wants to know if there's any way you could give her a break
and waive the deductible. How should the billing professional respond?
a. "Sorry, you cannot waive the deductible."
b. "You must come in and fill out a financial hardship form."
c. "You have to make payments, but you have 3 months to pay per company policy."
d. "I'll speak to Dr. Hamilton and see if there isn't anything that can be done to help you."
According to the OIG, you may waive the patient's deductible for Medicare if the patient demonstrates financial
hardship. You must keep a record of this form in the patient's records.

HIPAA and Compliance

19. Your neighbor's 17-year-old daughter was recently admitted to the hospital where you work in the
billing department. The nurse told you that she's asleep and your neighbor is out of town, but you
are curious what treatments she's received and want to make sure that she told the provider she is
allergic to latex. What do you do?
a. Ask your neighbor.
b. Just pull up her chart in the EHR so you do not bother anyone
c. Ask the nurse to let you know how her treatment is progressing
d. Update the chart to reflect that your neighbor is allergic to latex.
Accessing your neighbor's daughter's information in the EHR violates HIPAA's minimum necessary
requirement, where individuals only access the minimum amount of protected health information needed to do
their job. In instances where there is a "break the glass" safety feature in your hospital's EHR, this may send
an alert to compliance and you will be subject to discipline or a more serious employment action.

20. A Medicare RAC sends you a letter demanding that you repay Medicare $1,500 for 10 patient
accounts. You must:
a. Repay the RAC within 10 days
b. Send the RAC a letter stating why you cannot pay right now
c. Do nothing and let CMS take their money back as they please
d. Either a or b
You do not actually have to do anything. You can refute the RAC letter and provide documentation, file an
appeal or do nothing and the RAC will recoup their payments out of your next check from Medicare.

21. What does the acronym HIPAA stand for?

a. Health Insurance Probability and Accountability Act
b. Health Insurance Portability and Accountability Act
c. Health Insurance Privacy and Accountability Act
d. Health Information Privacy and Accountability Act
HIPAA stands for Health Insurance Portability and Accountability Act. It was enacted in 1996 to protect
individuals' health information while allowing the appropriate release health information needed to provide
high-quality health care. Its latest revision was in 2002.

22. Which part of HIPAA is primarily focused on protecting the privacy and security of health
information?
a. Insurance Reform
b. Administrative Simplification
c. Tax-Related Health Provisions
d. Application and Enforcement of Group Health Plan Requirements
Administrative Simplification sets national standards for electronic healthcare transactions and national
identifiers for providers, health insurance plans, and employers. It also includes the Privacy Rule and Security
Rule, which protect the confidentiality and integrity of health information.

23. The information of what number of patients must be improperly disclosed before the healthcare
organization is required to contact the local news media?
a. 5
b. 50
c. 500
d. 5000
According to the breach notification section of HIPAA, If 500 or more patients are exposed to a breach of their
private information, the local news media must be contacted. Anything less than that would require the
heathcare organization to report the breach to the Secretary of Health and Human Services.

24. A patient calls and asks that you send them their chart for their most recent visit. How much time
do you have to send them their records?
a. 5 days
b. 7 days
c. 10 days
d. 30 days
Under the Privacy Rule, HIPAA allows for 30 days and an additional 30 days can be added to the time period if
you inform the patient in writing.
Reimbursement and Collections

25. A provider bills $400 for a test. The insurance pays $300 and the patient's responsibility is $23.56.
What is the contractual discount and what is the patient's responsibility called?
a. $100, copay
b. $76.44, coinsurance
c. $100, coinsurance
d. $76.44, copay
Coinsurance is a percentage of the contractual allowance, while copays are a flat set amount. The contractual
allowance is the amount the provider was reimbursed directly plus the patient's responsibility, so the
contractual discount is the usual and customary amount (U&C) minus reimbursement and minus patient's
responsibility.

26. Capitation payments in healthcare are:

a. Payments made per service or procedure.
b. Fixed monthly payments made to a provider for each patient enrolled under their care.
c. Bonuses paid to providers for reducing healthcare costs.
d. Penalties for over-utilization of healthcare services.
Capitation is a way for healthcare service providers to be paid. For each enrolled person under this system,
physicians are paid a set amount, per period of time, whether or not that person seeks care.

27. What is a case mix index?

a. The ratio of male to female patients in a healthcare facility.
b. The distribution of healthcare providers to patients in a given area.
c. The variety of different types of health insurance that patients have within a healthcare provider's
patient population.
d. A description of the weight of diagnoses that patients have across the facility.
A case-mix index is the average Diagnosis-Related Group (DRG) weight for a facility. It is created by adding all
the weights of each patient's DRG and dividing it by the number of patients. This indicates the average
monthly payment that a hospital or facility can receive so they can plan financially.

28. Per Diem codes are reimbursed by:

a. Day
b. Unit
c. Patient
d. Session
Per Diem codes are reimbursed per day. Some examples of per diem codes include partial hospitalization
psychiatric codes, and some skilled nursing facility codes.

29. What is a clearinghouse and what purpose do they Study Online Instantly
serve?
a. Clearinghouses collect patient data in a centralized
location to promote interoperability in emergency
situations.
b. Clearinghouses distribute payments to providers from
third party payers.
c. Clearinghouses act as an intermediary between
insurances and providers to submit electronic claims.
d. Clearinghouses provide collections services for
patients who have not paid their bill.
Clearinghouses collect claims data and send it in a lump file to
each individual insurance for reimbursement. Clearinghouses
also receive and distribute ERAs and can provide additional
services, such as patient statements if requested, but do not
provide collections services.

30. A _____ is a monthly payment to purchase and continue

insurance coverage. A _______ is how much money you
must pay before your insurance begins to pay for
medical services. A _____ is a flat fee you must pay
every time you see the doctor and _______ is a
percentage you must pay in addition to other fees. (https://www.tests.com/Medical-Billing-
Practice-Exam)
a. Deductible, premium, coinsurance, copay
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b. Premium, deductible, copay, coinsurance
c. Premium, copay, deductible, coinsurance
d. Copay, coinsurance, deductible, premium
Premiums are paid monthly to insurance to continue coverage.
Deductibles must be paid before insurance begins to pay for
medical services. Copays are flat fees for each doctor's visit and
coinsurance is a percentage of the allowed amount that must be
paid in addition to copays and deductibles.

31. You are reading a Medicare RA. You see that Medicare has allowed the full amount but paid
nothing. The total allowed amount is $145. The claims adjustment reason code reads CO-1. What
do you do?
a. Call Medicare because they didn't pay.
b. Contact coding and see if they can fix the claim.
c. Send the patient a bill.
d. Submit the claim again with a modifier.
CO-1 means that the patient has not paid their deductible, so the allowed amount should be transferred to the
patient for them to pay.

32. What is a RVU and why is it important?

a. Resource Value Unit; it determines how much work goes into each procedure code.
b. Reimbursement Value Unit; it determines groups of similar procedures that are paid similarly.
c. Reimbursement Vantage Unit; it determines how weighty a procedure is and how it gets
reimbursed.
d. Relative Value Unit; RVUs are based on practice costs, physician work and malpractice insurance
and determine fee schedules.
Relative value units are combined with GPCIs and conversion factors to create the Medicare Fee-for-Service
fee schedule.
Medical Billing

33. A patient has cataract surgery, which has a 90-day global period. The patient's date of surgery was
1/1 and their date of transfer was 1/2. If you are billing CMS for post-operative care only, what
dates must you put in which box?
a. 1/1--4/1 in box 19
b. 1/2-4/2 in box 19
c. 1/1-4/2 in box 17
d. 1/2-4/2 in box 17
Medicare requires date of transfer, not date of surgery, as the beginning of the post-operative period. This
information goes in box 19.

34. If you are submitting a corrected claim, you must do the following:
a. Use Code 7 in box 22 with an ICN.
b. Write "CORRECTED CLAIM" in box 19.
c. Put the original claim number in box 23 and write "Corrected claim" in box 19.
d. Only use a paper claim so you can write "CORRECTED CLAIM" in big letters on the top.
Use code 7 for replacement claims and use the original claim number (ICN) in that box.

35. Sarah bills for the outpatient department for a hospital, where they are paid under the outpatient
prospective payment system. Sarah reviews a patient's account to begin the billing process and
sees an emergency department visit that includes lab work, an EKG, IV medication, and a simple
surgery. Which item will not be reimbursed if Sarah bills for it?
a. Emergency Department Visit Evaluation and Management Code
b. Lab Work
c. Simple Surgery
d. IV Medication

36. Daphne works at a doctor's office and submits a claim for an office visit for post-partum
complications right after the patient has given birth. What is the most likely reason for this claim
being denied?
a. Daphne did not use an appropriate modifier.
b. The wrong diagnosis was used.
c. The office visit is included in the global period postpartum.
d. The hospital must bill for this office visit.
Post-partum visits have a 42 day postpartum global period, so no office visits relating to the patient's
pregnancy may be billed. The patient needs to continue to see their OB-GYN for continuity of care.

37. In EMC ANSI 837, what are the boxes that were on CMS-1500 now called?
a. Sections and Areas
b. Loops and Segments
c. Squares and crofts
d. Sections and Segments
Loops and segments crosswalk to CMS-1500 boxes.

38. If the information on CMS 1500 in 24J is the same individual as the information in 32a, what is the
most likely cause?
a. It is a mistake that you need to call credentialing about.
b. The provider's NPI is wrong in 24J.
c. The provider is enrolled as a sole proprietor and only has an individual NPI.
d. The provider makes home visits.
The provider is enrolled as a sole proprietor and only has an individual NPI. Sole proprietors can use their
individual NPI as both a group and an individual NPI, but if they ever hire someone it makes billing a bit messy.
The group could also be put into box 24J, but since we're talking about individuals and not organizations, this
is not the most likely cause.

39. If a patient has both Medicare and Aetna, which insurance do you bill?
a. Medicare first, then Aetna. Medicare will send an RA to Aetna for COB.
b. Aetna first, then Medicare because private insurance should always be billed first.
c. Determine which insurance is primary and bill that first.
d. Check the patient's insurance card for instructions.
Medicare is always primary and Medicare will send an RA to Aetna (which may or may not make it, so it's
always good to follow up with another claim and COB to Aetna after receiving your remit from Medicare).

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40. What is a valid POS for an office?

a. Downtown
b. 11
c. In a hospital
d. 12
11 is the Place of Service (POS) that is billed for an office. 12
POS is a home visit.

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Medical Coding

41. When using a 50 modifier on a claim instead of using RT

and LT on a claim, remember that:
a. Anatomical modifiers are payment modifiers.
b. RT and LT increase payment by 150%.
c. A 50 modifier is a payment modifier.
d. A 50 modifier requires RT and LT to be billed.
A 50 Modifier is a payment modifier. RT and LT codes are
informational only, and are not required to be billed with a 50
modifier. RT and LT codes are used when a unilateral code is
billed to indicate it was done on more than one side and do not
affect the payment of the code. 50 modifiers, however, increase
reimbursement by 150% for a single line of code.

42. Which of the following is true about code J4010?

a. It is not a valid code.
b. It is a Category III code.
c. It is an anesthesia code.
d. It is a drug code.
J4010 is a drug code. All drugs are included in HCPCS Level II under the "J" section and can be found by the
table in the front of the HCPCS Level II book.

43. Which of the following codes are most likely to be NOT included in a code for an arm fracture
reduction surgery?
a. General anesthesia
b. Debridement
c. Lidocaine
d. Cast application
Per CMS NCCI policy, anesthesia is not covered as part of a fracture reduction. However, casting of the arm,
lidocaine for pain, and debridement of bone fragments are all included in the surgical procedure.

44. Dr. Smith sees a child patient for 15 minutes, then speaks to their parent for 45 minutes, carefully
detailing instructions for the child's care. If Dr. Smith is in an office, which code would be used for
this service?
a. 99417
b. 99215
c. 99214
d. 99358
E/M guidelines indicate to use 99417 when an evaluation and management service exceeds 55 minutes. Here,
when speaking to the patient's caregiver, we can include that time in the leveling of the service.

45. If a distinct evaluation and management service is billed with an injection, what modifier must be
attached?
a. 25 attached to the injection
b. 59 attached to the injection
c. 59 attached to the evaluation and management service
d. 25 attached to the evaluation and management service
A 25 modifier must be attached to the evaluation and management if documentation supports and it was a
significant and separate service apart from the injection.

46. A patient gets blood work done. They receive blood work that tests: CMP, albumin, urea,
potassium, chloride, creatinine and glucose. Everything but the CMP is denied. Why?
a. CMP includes all the other tests.
b. Those tests aren't reimbursable at your facility.
c. You needed a modifier on the tests to indicate they were part of a different blood panel.
d. The provider was incorrect and should have been billed under the facility instead of the doctor.
Comprehensive metabolic panel includes Albumin, Bilirubin, Calcium, Carbon dioxide Chloride, Creatinine,
Glucose, Phosphatase, Potassium, Protein, Sodium, ALT, AST, BUN. This is an example of unbundling.

47. A patient comes in for a consultation on back pain and ends up scheduling the surgery for next
week. What modifier should be added to the evaluation and management service?
a. 26
b. 57
c. 54
d. 59
Modifier 57 indicates that the evaluation and management service resulted in a decision for surgery.

48. A patient comes in for a follow up on their dressing. Three days before the patient had an incision
and drainage of a hematoma from their wrist, which was paid by the insurance. The follow up visit
was denied. Why?
a. The follow up procedure should have a modifier 24 to be paid.
b. The diagnosis code was most likely wrong. It needs to reflect "postoperative care".
c. The procedure has a 90-day global period and covers all related services within 90 days, so this will
not be paid.
d. The provider needed a referral for the follow up visit since it was a different person applying
dressings.
The procedure has a 90 day global period. The global payment covers all related procedures to the initial
procedure within those 90 days, including dressing changes.

49. A patient calls in, upset about their bill. They say they've been billed twice for the X-ray that they
received last month. You review the patient's chart and see that they have indeed been charged
the same code twice, one with TC and one with 26 modifiers. Why is this?
a. It's a mistake and you should submit a corrected claim right away
b. One charge is the facility charge for the X-ray. The other charge is the reading of the X-ray by the
radiologist.
c. This is fraud and you should report it to your supervisor.
d. One charge is for the X-ray technician and one charge is for the X-ray film.
One charge is for the facility and the other is for the reading of the X-ray. Radiologists (MDs) are not always
the ones performing the actual X-ray, which is mostly X-ray technicians employed by the hospital. Then the
radiologist both performs and interprets the X-ray and there is only one charge.
 50. What difference is there between inpatient and pro-fee coding and the way it is reimbursed?
a. Pro-fee is reimbursed on a fee schedule for CPT codes and uses ICD-10 CM diagnosis codes,
Inpatient is reimbursed by IPPS for ICD-10 CMs that are grouped as DRGs and uses ICD-10 PCS.
b. Pro-fee is reimbursed on a fee schedule for CPT codes and uses ICD-10 CM diagnosis codes,
Inpatient is reimbursed by ICD-10 PCS and uses ICD-10 CM diagnosis codes
c. Pro-fee is reimbursed based on a fee schedule for CPT codes and uses ICD-10 PCS diagnosis
codes, Inpatient is reimbursed by CPT codes by IPPS and uses ICD-10 CM diagnosis codes
d. Pro-fee is reimbursed on a fee schedule for ICD-10 CM and uses HCPCS, Inpatient is reimbursed
by HCPCS by IPPS and uses ICD-10 PCS diagnosis codes.
Professional fee visits are reimbursed on a fee schedule for each CPT code. ICD-10 CM diagnosis codes are
not reimbursable in the professional setting but are grouped as Diagnosis Related Groups (DRGs) in inpatient
setting and facility reimbursement is based off DRGs. ICD-10 PCS are procedure codes used in an inpatient
setting but receive no reimbursement.

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