What’s on the CBCS Exam? Billing and Coding Domain Breakdown (2026)
The NHA Certified Billing and Coding Specialist (CBCS) exam covers 4 content domains: The Revenue Cycle and Regulatory Compliance (15% of scored items), Insurance Eligibility and Other Payer Requirements (20%), Coding and Coding Guidelines (32%), and Billing and Reimbursement (33%). The exam totals 125 questions, 100 scored plus 25 unscored pretest items mixed in unmarked, delivered over 3 hours (180 minutes) at a PSI testing center or through Live Remote Proctoring. A passing result is a scaled score of 390 out of a possible 200 to 500 range. These domain weights come from NHA’s own CBCS Test Plan, built from a 2020 practice analysis of working billing and coding specialists. Billing and Reimbursement and Coding and Coding Guidelines together account for 65 of the 100 scored items, nearly two thirds of the exam, so most of the CBCS tests how a candidate processes a claim end to end rather than isolated fact recall. As of September 2026, the exam has been closed book since September 24, 2024: any coding reference information an application-of-coding question requires is provided alongside that question, not looked up in a manual. Here is the full domain by domain breakdown.
The 4 CBCS Domains and How Much Each One Counts
NHA builds the CBCS around a 2020 job task analysis of practicing billing and coding specialists, which is why the exam leans so heavily toward coding and claims handling rather than even coverage across topics. The bars below show each domain’s share of the 100 scored items, scaled so the largest domain reads at roughly 90% width.
Billing and Reimbursement: the Largest Domain (33%)
Billing and Reimbursement is the single biggest domain, covering how a claim moves from encounter to payment: charge capture from encounter documentation, CMS-1500 and 837P completion, UB-04 and CMS-1450 use, electronic and paper claim submission through clearinghouses, payer-specific guidelines, payer screens and edits, timely filing limits, payment posting, remittance advice and EOB interpretation, denials and rejections, appeals and resubmission, aging report analysis, determining patient and third-party financial responsibility, and collections processes and laws. A candidate who can only recite definitions will struggle here; the domain is built around applying those definitions to a claim in front of you, which is why scenario practice matters more than memorized vocabulary.
Coding and Coding Guidelines: Closed Book Since September 2024 (32%)
Coding and Coding Guidelines covers abstracting health information from clinical documentation, code set publishers and purposes across ICD-10-CM, ICD-10-PCS, CPT, and HCPCS, ICD-10-CM and CPT and HCPCS conventions and structure, modifier use, code sequencing, evaluation and management coding, place of service codes, specialty area coding, Medicare coding requirements, medical necessity criteria, telehealth coding considerations, and provider queries for documentation clarification. This is the domain most affected by the exam’s biggest recent change: since September 24, 2024, the CBCS has been closed book, and any coding reference information an application-of-coding question requires is displayed alongside that question rather than looked up in a physical manual. See Is the CBCS Exam Open Book for the full detail on what that change means for how you should prepare.
Insurance Eligibility and Regulatory Compliance: the Two Smaller Domains
Insurance Eligibility and Other Payer Requirements (20%) covers required insurance documentation, eligibility and benefits verification, out-of-network coverage considerations, insurance filing rules such as the dependent rule, birthday rule, and coordination of benefits, commercial plan types, government plans including Medicare Parts A through D, Medicaid, Medigap, and TRICARE, other third-party payers, referral and preauthorization processes, patient financial responsibility, uninsured and self-pay policies, and the advance beneficiary notice. The Revenue Cycle and Regulatory Compliance (15%), the smallest domain, covers the revenue cycle’s phases and how they interact, the laws and agencies that govern billing and coding such as HIPAA, HITECH, the False Claims Act, the Stark Law, and the Fair Debt Collection Practices Act, protected health information data elements and permitted disclosure, the OIG’s role in medical billing, compliance plan components and provider self-disclosure, indicators of billing fraud and abuse, consent types, and internal and third-party audits. Do not read the smaller weight as a reason to skip this domain: compliance concepts like HIPAA and fraud indicators also surface woven into scenario questions from the larger domains.
How These Domains Show Up in Practice
Understanding the weight of each domain matters most when it changes how you study. A study plan that spends equal time on all 4 domains will under-prepare you for the exam NHA actually gives, since Billing and Reimbursement and Coding and Coding Guidelines together carry nearly two thirds of the scored items. Practicing claim submission, remittance and EOB interpretation, denials and appeals, and coding conventions should take up the bulk of your review time, with Insurance Eligibility and Regulatory Compliance getting proportionally less. That does not mean skipping the smaller domains; a handful of missed items in a small domain still counts the same as a handful missed in a large one. Since the exam has been closed book since September 24, 2024, practice that mirrors the current scenario-based, reference-embedded format matters more than manual lookup speed.
Ready to see where you stand? Start a full CBCS practice test built around these exact domain weights, or try a free CBCS practice test to sample questions from across all 4 domains first.
Frequently Asked Questions
How many questions are on the CBCS exam?
125 total questions: 100 scored and 25 unscored pretest items mixed in unmarked, delivered over a 3 hour (180 minute) time limit.
What are the 4 domains on the CBCS exam?
The Revenue Cycle and Regulatory Compliance (15% of scored items), Insurance Eligibility and Other Payer Requirements (20%), Coding and Coding Guidelines (32%), and Billing and Reimbursement (33%).
Is the CBCS exam open book?
No. It has been closed book since September 24, 2024. Coding manuals are not needed or allowed; any reference information an application-of-coding question requires is displayed alongside that question.
What is the passing score on the CBCS exam?
A scaled score of 390 out of a possible 200 to 500 range.
Sources
- NHA Certified Billing and Coding Specialist (CBCS) Test Plan, nhanow.com (pre-dates the September 24, 2024 closed-book change)
- NHA Candidate Handbook, nhanow.com (updated June 2026)
- NHA, 2024 CBCS Study Guide, Practice Tests, and Exam: Common FAQ (NHA-published, confirms the September 24, 2024 closed book change)
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