The NHA Certified Billing and Coding Specialist (CBCS) exam has 100 scored questions (plus 25 unscored) in 3 hours, requires a scaled score of 390 out of 500 to pass, and costs about $117. The 2024 pass rate was 73.82%. Important recent change: coding manuals are no longer allowed — since September 2024, code information is provided alongside each question, so the exam tests coding judgment, not book navigation.
The CBCS, from the National Healthcareer Association, certifies entry into medical billing and coding — the revenue-cycle work that turns clinical documentation into clean claims and collected payments. NHA reports that 94% of employers require or encourage certification for billing and coding roles, and the CBCS is the most accessible national route in: one exam, standard NHA eligibility (high school diploma plus a training program in the last five years or qualifying work experience), and no membership fees. Like all eight NHA certifications, it's NCCA-accredited.
Its position in the market matters: the CBCS is the entry credential, while the AAPC's CPC is the deeper professional-coder standard. They're often stacked — CBCS to get hired into revenue-cycle work, CPC later for dedicated coding roles. If you're deciding between them now, see our full CBCS vs CPC comparison.
| Scored questions | 100 (plus 25 unscored pretest) |
| Time limit | 3 hours |
| Format | Multiple choice, computer-based |
| Passing score | 390 (scaled, 200–500) |
| 2024 pass rate | 73.82% (NHA official data) |
| Fee | ~$117 per attempt |
| Coding manuals | Not allowed since Sept 2024 — code info provided in-question |
| Delivery | Your institution, PSI centers, or live remote proctoring |
The current NHA test plan spreads the 100 scored items across four domains, with two-thirds of the exam living in coding and billing:
| Domain | ~Scored items |
|---|---|
| Billing & reimbursement (clean claims, remittance, denials, appeals, posting) | 33 |
| Coding guidelines (ICD-10-CM, CPT, HCPCS, modifiers, documentation support) | 32 |
| Insurance eligibility & payer requirements (verification, authorizations, medical necessity) | 20 |
| Revenue cycle & regulatory compliance (HIPAA, fraud/abuse, documentation) | 15 |
Since the manuals left the room, coding questions supply the candidate code descriptions alongside the scenario — the tested skill is choosing correctly among plausible codes based on the documentation, sequencing rules, and guidelines. Billing questions run the revenue cycle end to end: CMS-1500 fields, clearinghouse edits, EOB interpretation, denial reasons, and appeals. Compliance is the quiet point-loser: HIPAA disclosure rules and fraud-versus-abuse distinctions look easy and are written to be missed.
The 73.82% pass rate means one in four fails — usually not on coding, which training programs drill heavily, but on the billing and compliance domains those programs gloss over. The exam's reputation for being "straightforward" is itself the trap: NHA writes applied scenarios (read this documentation, pick the compliant action) rather than definition recall, and 125 questions in 180 minutes leaves under 90 seconds each once you account for reading documentation excerpts. The manual ban raised the bar for genuine coding-guideline knowledge: you can't flip to the answer anymore.
Plan 4–8 weeks of dedicated prep on top of any training program, weighted to your gaps: program graduates usually need billing-and-compliance reinforcement more than coding review, while self-taught candidates need the reverse. NHA's own domain diagnostic (your score report shows above/near/below per domain) is also how a retake, if needed, gets targeted.
Billing rules, payer requirements, and coding guidelines are exactly the kind of dense, similar-looking material that feels learned after a read-through and blurs under a clock. What separates them durably is retrieval practice — being forced to produce which form field, which modifier, which denial response — plus spaced repetition so early domains stay live while you cover later ones, and immediate correction of every miss.
Trelos is built entirely around those techniques. It teaches each concept, drills it with CBCS-style applied scenarios across all four domains, and schedules your reviews so the material sticks — weighted toward the billing and compliance items where the exam is actually decided.
Start the CBCS on Trelos — freeNo credit card. Feel the retention engine work in your first session.Your certification is valid for two years, renewed with 10 continuing-education credits (NHA's CE library is free for credential holders). Career-wise, the CBCS opens billing specialist, revenue-cycle, and coding-adjacent roles; many holders later add the CPC for dedicated coder positions or stack NHA credentials like the CMAA for front-office breadth. If you fail, NHA's standard retake rules apply: 30-day waits between attempts, and a 12-month wait after a third fail.