- What This Credential Actually Is
- Exam Format Snapshot
- Eligibility Checklist at a Glance
- Blueprint Weights: Content Categories
- The Second Classification: Task Allocations
- High-Yield Clinical Anchors by Domain
- Fees, Scoring Timeline, and Validity
- Renewal and Maintenance Rules
- Official Prep Resources
- Sequencing Your Review
- FAQ
- The credential is NCCPA's Certificate of Added Qualifications in Hospital Medicine (PA-C, CAQ-HM), not a physician board credential.
- The exam is 120 multiple-choice questions in two 60-question, 60-minute blocks, and closed blocks cannot be reopened.
- Cardiovascular (17%), Pulmonology (13%), and Infectious Diseases (12%) carry the heaviest content weights.
- Professional Practice is a real 6% category; do not drop it from your review.
What This Credential Actually Is
"CPA-HM" is the shorthand used on this site for the Certificate of Added Qualifications in Hospital Medicine, awarded by the National Commission on Certification of Physician Assistants (NCCPA). The formal designation is PA-C, CAQ-HM. It is an added qualification layered on top of your existing PA-C certification. It is not a separate initial PA certification, and it is not a physician hospital-medicine board credential.
If you want the full definition and naming background, see our explainers on what CPA-HM is and what CPA-HM stands for. This cheat sheet assumes you already know the basics and want the facts compressed onto one page.
Exam Format Snapshot
| Item | What to Know |
|---|---|
| Question count | 120 multiple-choice questions |
| Structure | Two 60-question blocks, 60 minutes each |
| Testing time | Two hours, excluding a separate 15-minute tutorial and 15-minute break |
| Test site | Pearson VUE test centers (initial exam) |
| Allowed materials | No books, no notes, no personal calculators |
| Navigation | Closed blocks cannot be reopened |
The closed-block rule changes how you should practice. Within a 60-question block you can flag and revisit items, but once you submit the block, those answers are final. Train yourself to finalize each block with a clear pass through every question, because there is no second chance to circle back after the break. The time budget works out to roughly one minute per question, so a single stalled item can cost you elsewhere in the block.
For a candid look at how the exam feels, read How Hard Is the CPA-HM Exam?
Eligibility Checklist at a Glance
The standard pathway requires all of the following. The full policy language is in the NCCPA CAQ policies document; our CPA-HM requirements guide walks through it in detail.
- Current PA-C certification.
- Unrestricted U.S. PA licensure (or unrestricted government-agency PA practice privileges), with every license you hold unrestricted.
- 3,000 hours of PA experience primarily managing hospitalized adults, within the six years before you attest the experience requirement is met.
- 75 hospital-medicine Category I CME credits within six years before applying, with at least 25 earned in the preceding two years.
- A risk-management CME activity counted within those 75 credits.
- A skills/patient-case attestation from the right signer.
The Attestation, Decoded
The attestation form covers procedural knowledge and system-based practice. It is not a separate timed practical exam.
- Standard pathway signer: a collaborating physician or lead/senior PA who works in hospital medicine and knows your practice.
- A physician or PA postgraduate program director may sign for a PA enrolled in or graduated from that program.
- Timing: submit it before the exam or within 90 days after score notification.
ACLS is recommended but is not an additional mandatory course. The risk-management activity, by contrast, is required.
The entire initial process, exam plus non-exam requirements, must be completed within six years. Plan your timeline using our exam dates and scheduling guide.
Blueprint Weights: Content Categories
NCCPA's content blueprint for the Hospital Medicine CAQ lists twelve medical content categories. These percentages describe how exam content is distributed, not a study curriculum, and the examples under each category are not exhaustive.
| Domain | Weight |
|---|---|
| Cardiovascular | 17% |
| Pulmonology | 13% |
| Infectious Diseases | 12% |
| Gastroenterology | 9% |
| Nephrology/Genitourinary | 9% |
| Hematology/Oncology | 8% |
| Neurology | 8% |
| Endocrinology | 6% |
| Professional Practice | 6% |
| Psychiatry | 5% |
| Perioperative Medicine | 4% |
| Allergy/Immunology/Rheumatology | 3% |
Together, Cardiovascular, Pulmonology, and Infectious Diseases account for 42% of the content. That makes them the obvious first targets, but the remaining nine categories make up the other 58%, so they cannot be skipped. For a category-by-category walkthrough, see the complete domains guide.
The Second Classification: Task Allocations
The same blueprint also allocates questions by clinical task. This is a second way of slicing the same exam, not eight additional domains.
| Task | Allocation |
|---|---|
| Patient Management | 20% |
| Ordering and Interpreting Diagnostic and Laboratory Studies | 16% |
| Formulating a Most Likely Diagnosis | 16% |
| Pharmaceutical Therapeutics | 16% |
| History Taking, Performing Physical Examination | 10% |
| Applying Scientific Concepts | 10% |
| Patient Education and Preventive Measures | 6% |
| Professional Practice | 6% |
A common mix-up: Patient Management at 20% is the largest task allocation, but it is not the largest medical-content weight. That title belongs to Cardiovascular at 17%. When you read a question stem, you can think in two layers: which organ system is this, and which task is it testing (diagnosis, test selection, drug choice, next management step)?
Key Takeaway
Because nearly half the task weight sits in management, diagnostics, and therapeutics combined, expect many questions to ask "what do you do next?" or "which agent is most appropriate?" rather than pure recall of definitions.
High-Yield Clinical Anchors by Domain
The blueprint does not enumerate every topic, so the points below are practice-oriented reminders for the kind of inpatient reasoning a hospital medicine exam rewards. Use them as prompts for your own review, not as an official topic list.
Cardiovascular (17%)
The largest single category. Think acute inpatient cardiology and the conditions you manage daily.
- Acute coronary syndromes: risk stratification, antithrombotic choices, post-event management
- Heart failure: decompensation, diuresis strategy, guideline-directed therapy at discharge
- Arrhythmias: rate versus rhythm control, anticoagulation decisions
- Hypertensive emergencies, syncope evaluation, valvular disease basics
Pulmonology (13%)
Respiratory failure and common inpatient lung disease dominate hospital practice.
- COPD and asthma exacerbations, including oxygen targets and steroid use
- Pulmonary embolism: diagnosis pathways and anticoagulation
- Pneumonia severity assessment and pleural disease
- Reading blood gases and recognizing when noninvasive ventilation is appropriate
Infectious Diseases (12%)
Antimicrobial reasoning is a recurring theme in inpatient work.
- Empiric antibiotic selection and de-escalation once cultures return
- Sepsis recognition and early management
- Skin and soft tissue, urinary, intra-abdominal, and bloodstream infections
- Hospital-acquired infections and stewardship principles
Gastroenterology and Nephrology/Genitourinary (9% each)
- GI bleeding evaluation, liver disease complications, pancreatitis, bowel obstruction
- Acute kidney injury etiology, electrolyte and acid-base disorders, renal dosing of medications
Hematology/Oncology, Neurology, Endocrinology, Psychiatry, and the Rest
- Anticoagulation management, anemia workups, transfusion thresholds, oncologic emergencies
- Stroke recognition, seizures, altered mental status
- Diabetic emergencies and inpatient glycemic management
- Delirium, withdrawal syndromes, medication-related psychiatric issues
- Perioperative risk assessment and co-management; allergy, immunology, and rheumatology presentations (smallest weight at 3%)
Fees, Scoring Timeline, and Validity
| Item | Detail |
|---|---|
| Registration/administrative fee | $100 |
| Examination fee | $250 |
| Initial total | $350 |
| Score release | Generally eight to ten weeks after administration, following validation |
| Validity | Ten years, with continuous PA-C and licensure eligibility |
Award requires both a passing score on the NCCPA specialty exam and completion of the applicable non-exam requirements. Passing the exam alone does not finish the process if your attestation or other items are outstanding. See the certification cost breakdown for budgeting around CME, study materials, and the optional practice exam.
A word of caution on numbers you may see elsewhere: a numeric passing threshold and an official specialty-specific pass rate were not verified in current NCCPA sources, and commercial pass-rate claims or "guarantees" are not reliable. Our pages on the passing score and pass rate explain what is and is not known.
Renewal and Maintenance Rules
- CME: 125 hospital-medicine Category I credits during the cycle, submitted by the time of the maintenance-exam application.
- Exam: You must pass the specialty exam to maintain the certificate.
- Attempts: The May 2026 governing policy permits three maintenance attempts in years nine and ten.
- Format options: Maintenance can be taken at a test center or through a distinct online format.
Online Maintenance Format
This differs sharply from the initial exam, so do not assume the same rules apply.
- 120 questions, with five minutes allotted per question
- Approximately six weeks to complete
- References are permitted, but your work must be independent
Official Prep Resources
- NCCPA Content Blueprint: the four-page document listing the twelve categories and task allocations. It is your scope authority.
- Sample Hospital Medicine Questions & Critiques: an NCCPA publication (copyright 2024) with sample items and rationales, useful for seeing the question style.
- NCCPA practice examination: optional, $50. NCCPA lists one practice form for this specialty, with a 180-day completion window. Its feedback is educational and does not predict whether you will pass.
For a full preparation roadmap, see the CPA-HM study guide, and when you are ready to test your recall under realistic conditions, try the CPA-HM practice questions.
Sequencing Your Review
Rather than a generic schedule, tie your calendar to the blueprint weights. Front-load the high-weight systems, then cover the long tail, and reserve the final stretch for mixed practice that mimics the two-block format.
Cardiovascular and Pulmonology
- 30% of content combined; build inpatient algorithms for ACS, heart failure, arrhythmias, PE, and COPD/asthma
- Practice blood gas and ECG interpretation without notes
Infectious Diseases, GI, Nephrology/GU
- Antimicrobial selection, de-escalation, and renal dosing together, since they interact constantly
- Electrolyte and acid-base reasoning
Hematology/Oncology, Neurology, Endocrinology, Psychiatry, Perioperative, Allergy/Immunology/Rheumatology
- Anticoagulation, stroke, inpatient glycemic control, delirium and withdrawal
- Review Professional Practice topics from your own hospital workflow
Timed Blocks and Critiques
- Do two 60-question, 60-minute blocks back to back with no references
- Work through the NCCPA sample critiques and the optional practice exam
Adjust the length to your own baseline. If your daily work is heavily cardiology-weighted, you may compress that block and spend longer on areas you rarely see, such as Allergy/Immunology/Rheumatology or Psychiatry.
Key Takeaway
Practice in the exam's real shape: 60 questions, 60 minutes, no notes, no reopening a closed block. Comfort with that constraint is a skill separate from clinical knowledge.
FAQ
No. It is an added qualification awarded by NCCPA to PAs who already hold a current PA-C. You must maintain PA-C and licensure eligibility throughout the ten-year validity period.
There are 120 multiple-choice questions in two 60-question blocks of 60 minutes each. The separate 15-minute tutorial and 15-minute break are not part of the two-hour testing time.
Cardiovascular (17%), Pulmonology (13%), and Infectious Diseases (12%) are the largest, totaling 42%. Still, the other nine categories, including Professional Practice at 6%, make up most of the exam, so cover them all.
The initial total is $350: a $100 registration/administrative fee and a $250 examination fee. The NCCPA practice exam is an optional extra $50. CME and study materials are separate costs.
That cannot be assumed. Compensation depends on employer, region, and role, and no certification-caused pay premium is established here. Review our ROI analysis and salary guide before making financial assumptions.
Use this sheet as a checklist, verify every policy detail against NCCPA's current documents before you register, and build your calendar around the blueprint weights. When you want hands-on repetition, work through our practice test platform and revisit the domains guide for areas where your scores lag.