ABIM certification, MOC and the LKA: format and fees

ABIM’s current fee for the initial Internal Medicine certification exam is $1,430. First-time candidates for the 2027 exam can apply for a 50% needs-based fee credit, worth $715, until October 16, 2026. Afterwards, most physicians maintain certification through the Longitudinal Knowledge Assessment, for an annual fee.

Last checked October 2026 against ABIM’s exam fees, MOC fees, FAQ and blog pages. The question counts come from a blueprint summary quoting ABIM’s January 2026 document and a prep site, and some third-party guides still list older or different fees.

The initial certification exam

• Fee. ABIM’s fee page lists $1,430 for Internal Medicine and $2,325 for its subspecialties. Late registration adds a non-refundable $400, and testing at an international center adds $500, per ABIM’s fee page.
• Format. A summary of ABIM’s January 2026 blueprint says up to 240 single-best-answer multiple-choice questions, with about 35 new questions that do not count. ABIM says the exam takes approximately 10 hours, in four sessions of up to 60 questions with 100 minutes of break time.
• Registration for 2027. ABIM says registration for the 2027 exam opens December 1, 2026. Candidates who receive a fee credit must still register separately, and the credit applies automatically when they pay.
• Fee credit. ABIM says more than 850 physicians received the 50% credit on their 2026 exam fee. It says decisions for the 2027 round will be communicated by mid-November.
• Refunds. ABIM’s fee page says you get 70% back if you cancel by 11:59 p.m. ET two days before your exam and 55% if you cancel later, 85% if your application is disapproved, and nothing if you don’t appear.
• Pass rates. ABIM publishes initial certification pass rates itself, so use its reports rather than third-party figures.

Maintenance of Certification

• Annual fee. $220 a year for the first certificate and $120 for each additional one, including access to the LKA, per ABIM. Payment is due by January 1, with a $40 fee if paid after the year in which it was due.
• Traditional 10-year exam. A $700 test center fee is due at registration, in addition to the annual fee. A study guide gives up to 220 questions.
• First year. ABIM’s FAQ says it waives the first year of MOC fees after you pass the Internal Medicine Certification Exam, and fellows’ fees are waived during accredited fellowship training, up to the years required.
• Every 10 years. A guide says you must pass an MOC assessment, either the traditional exam or the LKA.

The Longitudinal Knowledge Assessment

ABIM says that since it launched in 2022 more than 92,000 physicians have chosen to maintain more than 112,000 certificates through the LKA, and that 85% of those due for assessment in 2026 chose it over the 10-year exam. ABIM’s LKA page says you’re offered 30 questions a quarter over five years, 600 in total; you must open at least 500 and can skip up to 100, with 4 minutes per question plus an annual 30-minute time bank. See our LKA vs 10-year exam page.

Common questions