CCA Certification: Certified Coding Associate Exam Guide

The CCA (Certified Coding Associate) is a medical billing and coding certification issued by the American Health Information Management Association (AHIMA). It validates foundational knowledge in assigning medical codes for diagnoses and procedures across both inpatient and outpatient settings.

AHIMA positions the CCA as its entry-level coding credential, making it a natural starting point if you're new to the field or transitioning from another healthcare role. The credential demonstrates that you understand coding conventions, medical terminology, anatomy, and the classification systems used in health information management.

CCA holders work in hospitals, physician offices, outpatient clinics, billing companies, and health information departments. Unlike the CPC from AAPC, which focuses on outpatient physician-office coding, the CCA covers both inpatient and outpatient coding concepts. That gives you a broader foundational knowledge base.

The CCA exam has 105 questions (90 scored and 15 unscored pretest items) with a 2-hour time limit. You'll need a scaled score of 300 to pass (AHIMA).

The exam is administered at Pearson VUE testing centers in a computer-based format. One critical difference from most other certification exams: you can't move backward through questions. Once you answer and advance, you can't return to review or change your response. There's no option to flag items for later review (AHIMA).

This forward-only format means you need to be confident in each answer before advancing. The 2-hour time limit gives you roughly 1 minute and 9 seconds per question, so pacing is less pressured than the CPC exam, but the inability to go back adds its own challenge.

You'll need to bring current-year code books to the testing center. AHIMA publishes the required list for each exam cycle. Exams before May 1, 2026 require 2025 code books; exams on or after May 1, 2026 require 2026 editions. If you arrive without the correct books, you forfeit your exam fees (AHIMA).

The only formal requirement is a high school diploma or equivalent. AHIMA doesn't require you to complete a specific training program or have prior coding experience before taking the exam (AHIMA).

That said, AHIMA strongly recommends at least one of the following before you sit for the exam:

• Six months of direct coding experience in a healthcare setting.
• An AHIMA-approved coding program (PCAP) covering anatomy, medical terminology, and coding systems.
• Other coding training covering anatomy, medical terminology, and basic classification systems, even if not AHIMA-approved.

While these are recommendations rather than requirements, candidates without training or experience typically find the exam significantly harder. Most successful CCA candidates have completed at least a certificate program in medical coding before taking the exam.

The CCA tests foundational coding knowledge across both inpatient and outpatient settings. Unlike the CPC (which focuses heavily on CPT surgical coding), the CCA gives roughly equal weight to ICD-10-CM, ICD-10-PCS, and CPT. You'll also see questions on health information management, data quality, and compliance.

The inclusion of ICD-10-PCS is the biggest difference between the CCA and the CPC. ICD-10-PCS is the procedure coding system used for inpatient hospital procedures, and it doesn't appear on the CPC exam at all. If you're interested in hospital coding, this broader scope is an advantage.

The CCA must be renewed every two years. You'll need 20 continuing education units (CEUs) submitted within each cycle (AHIMA).

Of the 20 CEUs, at least 80% (16 CEUs) must come from Health Information and Informatics Management (HIIM) domain topics, which include core coding content like ICD-10-CM updates, CPT changes, coding compliance, and health data management. The remaining 20% (4 CEUs) can come from broader healthcare or professional development topics.

As of January 2025, AHIMA requires that at least 40% of CEUs come from AHIMA-approved sources, including AHIMA products, HCPro services, component state associations, and AHIMA-certified trainers (AHIMA). The recertification fee is $100 for AHIMA members or $218 for non-members (increasing to $249 on March 1, 2026).

The CCA works as a gateway credential for professionals entering the medical billing and coding field. It's recognized by hospitals, physician practices, health systems, and billing companies as evidence of foundational coding competency.

Because the CCA covers both inpatient and outpatient coding, it provides broader foundational knowledge than certifications focused solely on physician-office coding. That can be an advantage if you're looking at hospital coding positions or roles that span multiple care settings.

Many CCA holders use the credential as a stepping stone toward AHIMA's advanced certifications, particularly the CCS (Certified Coding Specialist). Holding a CCA plus one year of coding experience meets the CCS eligibility requirements (AHIMA). This makes the CCA a practical first step if your long-term goal is hospital coding.

The Bureau of Labor Statistics reports a median annual salary of $50,250 for medical records specialists (SOC 29-2072) as of May 2024. Certified professionals typically earn more than uncertified peers: the 2025 AAPC Salary Survey shows a 20.7% certification premium across the field. For detailed salary data, see our salary guide.

If you're set on outpatient physician-office coding and want the strongest possible credential for that niche, the CPC is the better pick. It's the most recognized coding certification in the U.S. and appears in more job postings.

If you want an affordable entry point, prefer AHIMA's health information management ecosystem, or plan to work in a hospital setting, the CCA makes sense. It costs less than half the CPC, has lower barriers to entry, and covers inpatient coding that the CPC doesn't touch.

Many professionals start with the CCA and later add the CPC or CCS. There's no rule against holding certifications from both AAPC and AHIMA, and some employers specifically value that combination. For a side-by-side look at all five major certifications, see our certification comparison guide.