NCCT NCICS Certification Exam | National Certified Insurance
& Coding Specialist Practice Questions & Detailed Rationales
2026/2027
Question 1
What is the purpose of using the placeholder character "x" in certain
ICD-10-CM diagnosis codes?
A. To indicate that the code is completely optional
B. To allow for future expansion and fill empty characters when a code
requires a 6th or 7th character extension
C. To signify that the diagnosis is unconfirmed or ruled out
D. To represent an unspecified patient age
Correct Answer: B. To allow for future expansion and fill empty
characters when a code requires a 6th or 7th character extension
Detailed Rationale: The ICD-10-CM coding system utilizes the
placeholder letter "x" to occupy empty spaces when a code has fewer
than six characters but requires a 7th character extension (such as for
encounter type or fracture healing).
Question 2
What standard paper claim form is universally utilized by physicians and
non-physician practitioners to bill outpatient services to third-party
payers and Medicare?
A. UB-04 (CMS-1450)
,B. CMS-1500
C. ADA Dental Claim Form
D. Superbill
Correct Answer: B. CMS-1500
Detailed Rationale: The CMS-1500 is the standard professional claim
form used by healthcare providers and suppliers to bill Medicare and
private commercial insurance carriers for outpatient services.
Question 3
Which CPT modifier is appended to an Evaluation and Management
(E/M) service code to indicate that it was a significant, separately
identifiable service performed by the same physician on the same day
as a procedure or other service?
A. Modifier 25
B. Modifier 59
C. Modifier 51
D. Modifier 24
Correct Answer: A. Modifier 25
Detailed Rationale: Modifier 25 indicates that on the day a procedure
was performed, the patient's condition required a significant, separately
identifiable E/M service above and beyond the usual pre-operative and
post-operative care associated with the procedure.
Question 4
,Which part of the Medicare program primarily covers inpatient
hospitalizations, skilled nursing facility stays, home health care, and
hospice care?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Correct Answer: A. Medicare Part A
Detailed Rationale: Medicare Part A provides hospital insurance
covering inpatient care, skilled nursing facilities, hospice, and select
home healthcare services. Part B covers outpatient medical services,
and Part D covers prescription drugs.
Question 5
What type of medical codes are found in HCPCS Level II and are
specifically used to report supplies, injections, durable medical
equipment (DME), and services not included in the standard CPT
codebook?
A. Alphabetic codes starting with letters A through V
B. Category III CPT temporary codes
C. ICD-10 procedure codes
D. Modifier codes only
Correct Answer: A. Alphabetic codes starting with letters A through V
, Detailed Rationale: HCPCS Level II codes consist of a single letter
followed by four numbers (e.g., E-codes for durable medical equipment,
J-codes for drugs administered other than oral) used primarily for billing
non-physician services and supplies.
Question 6
When a patient is covered by more than one health insurance policy,
what process determines which insurance plan pays primary benefits
and which plan pays secondary benefits?
A. Pre-authorization
B. Coordination of Benefits (COB)
C. Medical necessity review
D. Retrospective auditing
Correct Answer: B. Coordination of Benefits (COB)
Detailed Rationale: Coordination of Benefits (COB) establishes the
order of payment when a patient has dual coverage, ensuring that total
plan payments do not exceed 100 percent of the allowable medical
expenses.
Question 7
What legal term describes the intentional submission of false claims or
misrepresentation of medical facts to an insurance carrier to obtain
unearned financial benefit or reimbursement?
A. Medical abuse
B. Medical fraud
C. Upcoding
& Coding Specialist Practice Questions & Detailed Rationales
2026/2027
Question 1
What is the purpose of using the placeholder character "x" in certain
ICD-10-CM diagnosis codes?
A. To indicate that the code is completely optional
B. To allow for future expansion and fill empty characters when a code
requires a 6th or 7th character extension
C. To signify that the diagnosis is unconfirmed or ruled out
D. To represent an unspecified patient age
Correct Answer: B. To allow for future expansion and fill empty
characters when a code requires a 6th or 7th character extension
Detailed Rationale: The ICD-10-CM coding system utilizes the
placeholder letter "x" to occupy empty spaces when a code has fewer
than six characters but requires a 7th character extension (such as for
encounter type or fracture healing).
Question 2
What standard paper claim form is universally utilized by physicians and
non-physician practitioners to bill outpatient services to third-party
payers and Medicare?
A. UB-04 (CMS-1450)
,B. CMS-1500
C. ADA Dental Claim Form
D. Superbill
Correct Answer: B. CMS-1500
Detailed Rationale: The CMS-1500 is the standard professional claim
form used by healthcare providers and suppliers to bill Medicare and
private commercial insurance carriers for outpatient services.
Question 3
Which CPT modifier is appended to an Evaluation and Management
(E/M) service code to indicate that it was a significant, separately
identifiable service performed by the same physician on the same day
as a procedure or other service?
A. Modifier 25
B. Modifier 59
C. Modifier 51
D. Modifier 24
Correct Answer: A. Modifier 25
Detailed Rationale: Modifier 25 indicates that on the day a procedure
was performed, the patient's condition required a significant, separately
identifiable E/M service above and beyond the usual pre-operative and
post-operative care associated with the procedure.
Question 4
,Which part of the Medicare program primarily covers inpatient
hospitalizations, skilled nursing facility stays, home health care, and
hospice care?
A. Medicare Part A
B. Medicare Part B
C. Medicare Part C
D. Medicare Part D
Correct Answer: A. Medicare Part A
Detailed Rationale: Medicare Part A provides hospital insurance
covering inpatient care, skilled nursing facilities, hospice, and select
home healthcare services. Part B covers outpatient medical services,
and Part D covers prescription drugs.
Question 5
What type of medical codes are found in HCPCS Level II and are
specifically used to report supplies, injections, durable medical
equipment (DME), and services not included in the standard CPT
codebook?
A. Alphabetic codes starting with letters A through V
B. Category III CPT temporary codes
C. ICD-10 procedure codes
D. Modifier codes only
Correct Answer: A. Alphabetic codes starting with letters A through V
, Detailed Rationale: HCPCS Level II codes consist of a single letter
followed by four numbers (e.g., E-codes for durable medical equipment,
J-codes for drugs administered other than oral) used primarily for billing
non-physician services and supplies.
Question 6
When a patient is covered by more than one health insurance policy,
what process determines which insurance plan pays primary benefits
and which plan pays secondary benefits?
A. Pre-authorization
B. Coordination of Benefits (COB)
C. Medical necessity review
D. Retrospective auditing
Correct Answer: B. Coordination of Benefits (COB)
Detailed Rationale: Coordination of Benefits (COB) establishes the
order of payment when a patient has dual coverage, ensuring that total
plan payments do not exceed 100 percent of the allowable medical
expenses.
Question 7
What legal term describes the intentional submission of false claims or
misrepresentation of medical facts to an insurance carrier to obtain
unearned financial benefit or reimbursement?
A. Medical abuse
B. Medical fraud
C. Upcoding
