Only 10% of Certified Medical Coders Work in Small Practices

Just 10% of certified medical coders and billers worked in small physician practices in 2025, down from 22.4% in 2010, according to AAPC's 2026 Medical Coding and Billing Salary Report. The average medical records specialist earned $65,007 that year, and the gap between what a health system pays and what a small practice pays helps explain why that share keeps falling.

AAPC surveyed more than 20,000 of its members for the report, covering coders, billers, auditors, compliance officers, and other revenue cycle roles across the United States. The findings point to a widening split: certification and stacked credentials raise pay by tens of thousands of dollars a year, and the practices that most need that expertise are the ones least likely to keep it in-house.

For a practice manager, this is not a workforce curiosity. Coding and billing accuracy sets the pace of a practice's cash flow, and the AAPC data shows that the people who do that work well have more employers bidding for them than at any point since 2010.

What Certified Coders Earn in 2026

Medical records specialists, AAPC's umbrella term for coders, billers, and related revenue cycle staff, averaged $65,007 in annual pay in 2025. That figure runs 3.0% above the 2025 national average across all U.S. occupations, based on Department of Labor wage data cited in the report.

Certification widens the gap further. AAPC members holding an active certification averaged $67,260 a year, versus $55,721 for members without one, a 20.7% difference. Pay also varies by geography: state averages spread by more than 50.0% from lowest to highest, and Washington, D.C. ranks among the highest-paying markets at $62,810 a year. A practice budgeting off a national or regional survey number without adjusting for its own state risks setting a job posting well under what a certified candidate can get down the street.

Stacking Certifications and Degrees Both Pay Off

A single credential is only the starting point. AAPC members who hold two certifications averaged $71,130 in 2025, and those with three or more averaged $76,035, well above the single-certification average of $67,260. For a practice that pays exam fees and continuing education for a second specialty certification, the AAPC numbers suggest that cost functions as a retention tool as much as a credential for the employee's resume.

Formal education moves the number too, though less than a stack of certifications does. Members with no college averaged $61,635, those with some college or an associate degree averaged $62,643, bachelor's degree holders averaged $68,354, 11.0% above the no-college group, and those with a master's degree averaged $82,207, 33.0% above the no-college baseline. The spread between a single certification and a bachelor's degree is narrow, which is part of why AAPC's certification-track members keep adding credentials rather than returning to school.

Source: AAPC, 2026 Medical Coding and Billing Salary Report.

Experience Pays Off Slowly

Years on the job matter, but the climb is gradual rather than steep. AAPC members at the start of their careers, with zero to one year of experience, averaged $45,377 in 2025, while those with 10 to 15 years of experience averaged $67,331. Across a full career, AAPC's data shows average earnings grow 77.4% from entry level to late career.

One credential moved faster than the rest. The Certified Professional Compliance Officer designation, which averaged $94,017 in 2025, was one of only two credentials whose holders gained more than $2,500 in average pay between 2024 and 2025, a steeper one-year jump than the broader membership saw. That jump matters for a practice weighing whether compliance work belongs on staff or with an outside firm: the credential that pays the most is also the one getting more expensive the fastest.

Small Practices Are Losing the Talent Pool

Where these coders and billers actually work has shifted hard toward larger organizations. Only 10% of AAPC's 2025 survey respondents reported working for a small physician practice, down from 22.4% in 2010. Health systems and hospitals now employ most of the certified workforce that independent practices once staffed directly.

Pay explains part of the shift. Health systems averaged $67,657 a year for medical records specialists, the highest of any setting AAPC tracked, and individual hospitals averaged $65,396, the second highest. AAPC put the health-system premium over a solo or small physician-group practice at 27.0%. A specialist choosing between a health system opening and a small-practice opening at 2025 average pay is choosing between two very different career tracks, and the AAPC numbers show most of them are choosing the larger employer.

Source: AAPC, 2026 Medical Coding and Billing Salary Report.

What This Means for Independent Practices

A practice competing against a 27.0% pay gap will lose experienced coders and billers to the nearest health system unless it closes some of that gap, through pay or a clearer path to a second or third certification worth $9,000 to $15,000 a year over the single-certification baseline. With only 10% of the certified workforce still choosing small practices, recruiting into that pool has gotten harder every year since 2010's 22.4% share.

The practices still competing for this talent are fighting a widening pay curve, from $45,377 at entry level to $67,331 at 10 to 15 years, that a small operation has to fund out of the same billing volume a much larger organization spreads across more patients. Outsourcing part of the coding or billing function to a firm that already pays health-system-level wages, spread across many clients, is one way independent practices have responded to that math without matching a 27.0% raise on their own payroll.

Small practices still hire certified coders and billers every year. The budget conversation has simply moved: a job posting written to 2020 pay expectations will not clear the $67,260 certified average AAPC reported for 2025, let alone the $71,130 to $76,035 range for a coder carrying two or three certifications.

Sources

• AAPC, "2026 Medical Coding and Billing Salary Report," 2026
• AAPC Knowledge Center, "Salary Survey Shows AAPC Members' Income Potential," 2026