100+ Free NCICS Practice Questions

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Under the Birthday Rule for a dependent child covered by both parents' employer plans, the primary plan is the one belonging to the parent whose:

Birthday falls earlier in the calendar year (month and day)

Policy was effective first

Birthday falls later in the calendar year

Last name comes first alphabetically

to track

2026 Statistics

Key Facts: NCICS Exam

100

Scored Items

NCCT 2025 Test Plan

70%

Passing Score

NCCT

3 hours

Exam Time

NCCT

$119

Exam Fee

NCCT

30%

Medical Coding Weight

NCCT 2025 Test Plan

Alternative Item Format

Drag-drop, multi-select, hotspot

The NCICS (National Certified Insurance and Coding Specialist) is awarded by the National Center for Competency Testing (NCCT). The exam contains 100 scored items plus 25 unscored pretest items (125 total) over 3 hours, requires 70% to pass, and costs $119. The 2025 detailed test plan distributes scored items as Medical Coding (30), Medical Claims Submission (23), Medical Benefits and Eligibility (16), Law and Ethics (16), and Payments and Collection Management (15). Eligibility routes include current students, graduates within 5 years, 1+ year of verifiable experience, military service, or NCCT-authorized instructors.

Sample NCICS Practice Questions

Try these sample questions to test your NCICS exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Under the Birthday Rule for a dependent child covered by both parents' employer plans, the primary plan is the one belonging to the parent whose:

A.Birthday falls earlier in the calendar year (month and day)

B.Policy was effective first

C.Birthday falls later in the calendar year

D.Last name comes first alphabetically

Explanation: The Birthday Rule names as primary the plan of the parent whose birthday (month and day, ignoring year) falls earlier in the calendar year. The other parent's plan becomes secondary. Year of birth is irrelevant.

2A 67-year-old patient is covered by Medicare and a commercial group plan through her actively-employed spouse (employer has 12 employees). Which payer is primary?

A.Medicare

B.Commercial group plan

C.Medicaid

D.The patient pays first

Explanation: Under Medicare Secondary Payer rules, an employer group health plan is primary to Medicare only when the employer has 20 or more employees (for the aged). With fewer than 20 employees, the group plan is secondary and Medicare is primary.

3Pre-authorization is BEST defined as:

A.A guarantee that the payer will pay the claim

B.Approval from the payer that a planned service is medically necessary before it is rendered

C.A discount negotiated with the provider

D.The amount the patient owes after the deductible

Explanation: Pre-authorization is the payer's prospective determination that a planned service meets medical-necessity criteria. It is not a guarantee of payment—claims must still be submitted and may be denied for eligibility, coding, or documentation reasons.

4A new patient presents with a referral from her primary care physician for an in-network specialist. Before the visit, the coding specialist should FIRST:

A.Submit the claim with a referral modifier

B.Verify insurance eligibility and the active referral

C.Collect the full charge from the patient

D.Apply ICD-10-CM Z-codes for the encounter

Explanation: Verifying eligibility and confirming an active, valid referral before the visit prevents denied claims and unexpected patient balances. Eligibility verification is the foundation of clean-claim workflow.

5Which Medicare part covers outpatient physician services and durable medical equipment?

A.Part A

B.Part B

C.Part C

D.Part D

Explanation: Medicare Part B covers physician services, outpatient care, preventive services, and durable medical equipment (DME). Part A covers inpatient hospital, SNF, hospice, and some home health. Part C is Medicare Advantage and Part D is prescription drugs.

6A patient has an HMO plan. The specialist visit is denied because:

A.The patient did not obtain a referral from the PCP

B.HMOs do not cover specialist visits

C.The specialist must be out-of-network

D.Patients must pay cash up front

Explanation: Traditional HMO plans require the member to obtain a referral from the primary care physician before seeing a specialist. Without a documented referral on file with the payer, the specialist claim is typically denied.

7A pre-determination is most accurately described as:

A.The same as a pre-authorization

B.An advance estimate of benefits the payer will pay for a planned service

C.The patient's portion after deductible

D.The denial reason code

Explanation: A pre-determination is a non-binding written estimate from the payer of how much it will pay for a planned procedure. Unlike pre-authorization, it does not address medical necessity—it estimates benefit allocation.

8TRICARE Prime requires beneficiaries to:

A.Pay full charges with no insurance

B.Use military treatment facilities or in-network civilian providers and obtain referrals

C.Use only Medicare providers

D.Pay a 20% coinsurance with no deductible

Explanation: TRICARE Prime is the managed-care HMO-style option for active-duty members and families. Beneficiaries are assigned a primary care manager, must obtain referrals for specialty care, and use military facilities or TRICARE network civilian providers.

9Coordination of Benefits (COB) is used to:

A.Determine the order in which multiple insurance plans pay a claim

B.Assign ICD-10-CM codes

C.Calculate the patient's deductible

D.Verify a patient's identity

Explanation: COB rules establish the order of payment when a patient is covered by more than one health plan. The primary payer adjudicates first; the secondary picks up amounts allowed by COB rules and contracts. COB prevents duplicate payments exceeding 100% of charges.

10A patient owes a $30 copay for an office visit. The copay should be collected:

A.After the insurance payment is received

B.At the time of service

C.Only if the visit is denied

D.Annually with the deductible

Explanation: Copays are fixed amounts the patient owes for each visit and should be collected at time of service per practice financial policy. Most payer contracts require providers to collect the copay; waiving it routinely can be a False Claims violation.

About the NCICS Exam

NCCT credential for medical billers and coders. The NCICS exam covers ICD-10-CM, CPT, HCPCS Level II, claims submission, payments, and HIPAA. Pass on your first try with realistic practice questions.

Questions

125 scored questions

Time Limit

3 hours

Passing Score

70%

Exam Fee

$119 (NCCT)

NCICS Exam Content Outline

30%

Medical Coding

ICD-10-CM (11 items), CPT (12 items), HCPCS Level II (7 items): abstracting, sequencing, guidelines, modifiers

23%

Medical Claims Submission

CMS-1500 completion, clean claims, commercial and government plans, Workers' Comp, encounter forms, fee schedules

16%

Medical Benefits and Eligibility

Eligibility verification, referrals, Birthday Rule, primary/secondary determination, pre-authorizations, patient collections

16%

Law and Ethics

HIPAA, HITECH, Stark Law, Anti-Kickback, False Claims Act, scope of practice, fraud and abuse, FDCPA

15%

Payments and Collection Management

EOB/RA interpretation, payment posting, denied/rejected claims, A/R management, deductibles and co-insurance

How to Pass the NCICS Exam

What You Need to Know

Passing score: 70%
Exam length: 125 questions
Time limit: 3 hours
Exam fee: $119

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

NCICS Study Tips from Top Performers

1Master Medical Coding (30% of exam) - learn ICD-10-CM coding conventions, CPT modifier usage, and HCPCS Level II G/J/L codes cold

2Memorize the CMS-1500 form fields - claim submission is 23% of the exam and depends on accurate Box 17, 21, 24, and 33 entries

3Know HIPAA, HITECH, Stark, Anti-Kickback, and False Claims Act - Law and Ethics is 16% of the exam

4Practice the Birthday Rule and primary/secondary insurance determination until automatic

5Use our AI tutor to walk through denial codes (CARC/RARC), EOB interpretation, and the appeal process

Frequently Asked Questions

What is the NCICS exam pass rate?

NCCT does not publish a pass rate for the NCICS exam. The exam requires 70% to pass and contains 100 scored items plus 25 unscored pretest items administered over 3 hours. Candidates who complete an NCCT-authorized program and use targeted practice questions consistently report passing on their first attempt.

How many questions are on the NCICS exam?

The NCICS exam contains 100 scored items and 25 unscored pretest items (125 total). About 92% are standard 4-option multiple-choice questions and 8% are alternative items such as drag-and-drop, multi-select, and hotspot. You have 3 hours to complete the exam.

How is the NCICS different from the NHA CBCS exam?

The NCICS is administered by NCCT and weights heavily toward medical coding (30%) including ICD-10-CM, CPT, and HCPCS Level II. The NHA CBCS is administered by the National Healthcareers Association and emphasizes billing workflow with a smaller coding focus. They are separate credentials from different bodies; many billing/coding professionals hold one or the other.

What does the NCICS exam cover?

The 2025 NCCT test plan covers Medical Coding (30 items: ICD, CPT, HCPCS), Medical Claims Submission (23 items: CMS-1500, commercial and government plans), Medical Benefits and Eligibility (16 items: verification, Birthday Rule, pre-authorizations), Law and Ethics (16 items: HIPAA, Stark, Anti-Kickback, False Claims), and Payments and Collection Management (15 items: EOB, A/R, denials).

Who is eligible to sit for the NCICS exam?

All candidates need a US high school diploma or GED. Eligibility routes include: (1) current students in NCCT-authorized Insurance and Coding programs, (2) graduates of NCCT-authorized programs within the past 5 years, (3) professionals with at least 1 year of verifiable full-time experience within the past 5 years, (4) qualifying military service, or (5) instructors with 1+ year of current teaching at an NCCT-authorized school.

How much does the NCICS exam cost?

The NCICS exam fee is $119, payable to NCCT. NCCT-authorized schools may bundle the exam fee into program tuition. Recertification requires continuing education credits and an annual maintenance fee.

How long should I study for the NCICS exam?

Plan for 60-100 hours of study over 6-10 weeks if you have completed an insurance and coding program, or 100-150 hours if you are testing through the experience route. Focus heavily on Medical Coding (30% of exam) including ICD-10-CM coding conventions, CPT modifiers, and HCPCS Level II. Aim to consistently score 80%+ on practice exams before scheduling.