AAPC CPB - CHAPTER 9 PRACTICAL APPLICATION EXAM LATEST
2026 UPDATED QUESTIONS AND VERIFIED 100% SOLUTIONS
(2026/2027) GRADE: A+|STATUS: GUARANTEED PASS
Case 1 - Clearinghouse Rejections Report
Status: 9/17/20XX Contents: C4120 - Invalid information procedure
code/modifier for 99213-22; REJECTED BY SYSTEM EDI; Rejected
Patient Name: Williams, Kara
Patient Number: 543789
Payer: AAPC Health Plan
Submission Date: 9/17/XX
Date of Service: 9/16/XX
Charge: $250.00
Provider: Post, Alexis
According to this clearinghouse rejections report, what actions should be taken on the claim for
Kara Williams, Date of Service 9/16/20XX?
I. Check with the provider to determine what codes should be reported.
II. Review the CPT codes and modifiers to determine if they can be reported together.
III. Adjust the charge; it is not covered by the carrier.
IV. Override the clearinghouse edit.
a. I and III
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, b. II and IV
c. I and II
d. II and III - Answers -c. I and II
Response Feedback:
The clearinghouse rejected the service because the modifier and CPT combination is not valid.
Modifier 22 is only reportable on surgical procedure codes, not office visits. In this case, the
biller should review the codes and check with the provider to verify what CPT and modifiers
should be reported.
Case 2 - Preauthorization policy
AAPC Health Plan Prior Authorization Policy
Participating providers arranging and providing outpatient diagnostic imaging services for these
members are required to comply with the program's prior authorization requirements for the
services listed below when performed in a physician's office, outpatient department of a
hospital, or freestanding imaging center:
-CT/CTA scans
-MRI/MRA scans
-Nuclear cardiology studies
-PET scans
-Echocardiography
Prior authorization can be obtained and/or confirmed online by logging onto
www.aapchealthplan.net.
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2026 UPDATED QUESTIONS AND VERIFIED 100% SOLUTIONS
(2026/2027) GRADE: A+|STATUS: GUARANTEED PASS
Case 1 - Clearinghouse Rejections Report
Status: 9/17/20XX Contents: C4120 - Invalid information procedure
code/modifier for 99213-22; REJECTED BY SYSTEM EDI; Rejected
Patient Name: Williams, Kara
Patient Number: 543789
Payer: AAPC Health Plan
Submission Date: 9/17/XX
Date of Service: 9/16/XX
Charge: $250.00
Provider: Post, Alexis
According to this clearinghouse rejections report, what actions should be taken on the claim for
Kara Williams, Date of Service 9/16/20XX?
I. Check with the provider to determine what codes should be reported.
II. Review the CPT codes and modifiers to determine if they can be reported together.
III. Adjust the charge; it is not covered by the carrier.
IV. Override the clearinghouse edit.
a. I and III
1|Page
, b. II and IV
c. I and II
d. II and III - Answers -c. I and II
Response Feedback:
The clearinghouse rejected the service because the modifier and CPT combination is not valid.
Modifier 22 is only reportable on surgical procedure codes, not office visits. In this case, the
biller should review the codes and check with the provider to verify what CPT and modifiers
should be reported.
Case 2 - Preauthorization policy
AAPC Health Plan Prior Authorization Policy
Participating providers arranging and providing outpatient diagnostic imaging services for these
members are required to comply with the program's prior authorization requirements for the
services listed below when performed in a physician's office, outpatient department of a
hospital, or freestanding imaging center:
-CT/CTA scans
-MRI/MRA scans
-Nuclear cardiology studies
-PET scans
-Echocardiography
Prior authorization can be obtained and/or confirmed online by logging onto
www.aapchealthplan.net.
2|Page
