10 free, exam-style Certified Professional Biller (CPB) practice questions with answers and explanations. No signup required. Work through them below, then take the full free CPB practice test to study every exam domain.
A non-participating Medicare provider does not accept assignment on a claim. The Medicare Physician Fee Schedule allowed amount for participating providers is $200.00. What is the MAXIMUM amount this provider may charge the Medicare beneficiary?
Correct answer: C - $218.50
A 67-year-old Medicare beneficiary works full-time and has group health plan (GHP) coverage through her employer, which has 18 employees. She visits an orthopedic surgeon for a knee injury unrelated to work. Which payer should be billed as primary?
Correct answer: B - Medicare, because the employer has fewer than 20 employees
A Medicare Part B claim is denied at the Redetermination level by the MAC. The provider disagrees with the decision and wants to escalate. What is the next level of appeal, and which entity will review the claim?
Correct answer: B - Reconsideration by a Qualified Independent Contractor (QIC)
A surgeon performs a total hip replacement (90-day global period). Three weeks post-operatively, the patient develops a wound infection requiring a return to the operating room for irrigation and debridement. Which modifier should be appended to the I&D procedure code?
Correct answer: B - Modifier -78: Unplanned return to the operating room for a related procedure during the postoperative period
A participating Medicare provider bills $350.00 for an office visit. The Medicare allowed amount is $180.00. The patient has met $100.00 of the $240.00 annual Part B deductible. Based on this information, what is the patient's total financial responsibility?
Correct answer: B - $148.00
A physician refers all of his Medicare patients needing MRI services to an imaging center in which he holds a 15% ownership interest. No Stark Law exception applies. Which statement BEST describes the physician's legal liability?
Correct answer: B - The physician is liable regardless of intent because the Stark Law is a strict liability statute
A provider orders a diagnostic test for a Medicare patient that is expected to be denied as not medically necessary based on the Local Coverage Determination. The office fails to have the patient sign an Advance Beneficiary Notice (ABN) before performing the test. Which modifier should the biller append to the claim?
Correct answer: C - Modifier -GZ: Item or service expected to be denied as not reasonable and necessary
A biller reviews the NCCI Procedure-to-Procedure (PTP) edits and finds that two CPT codes billed on the same date of service are flagged with a modifier indicator of 0. The physician documented that the services were performed on separate anatomic sites. What action should the biller take?
Correct answer: C - Do not bill both codes together; a modifier indicator of 0 means the edit cannot be overridden
A 6-year-old child is covered under both parents' employer-sponsored health plans. The mother's date of birth is October 3, 1990. The father's date of birth is March 22, 1988. Neither parent has custody provisions affecting coverage. Under standard Coordination of Benefits rules, which plan is primary for the child?
Correct answer: B - The father's plan, because the father's birthday falls earlier in the calendar year
A biller receives a remittance advice for a Medicare claim showing the following adjustment: Group Code CO, CARC 97 - "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated." What does this adjustment indicate, and who is financially responsible?
Correct answer: B - The service is bundled into another service already paid; the adjustment is the provider's contractual write-off and cannot be billed to the patient
Practice hundreds more CPB questions with instant scoring, weak-area drills, and full exam simulations.