- What the RRT Credential Actually Is
- The Two-Exam Route: TMC Then CSE
- Who Can Sit for the Exams
- Fees, Registration, and Test-Day Rules
- The Six Content Headings Across Both Exams
- How the CSE Assembles Its Cases
- Reading the 2025 Pass-Rate Data Correctly
- The 2027 Transition: What Changes and What Does Not
- Keeping the Credential: The CMP
- Where Registered Respiratory Therapists Work
- Sequencing Your Preparation
- Frequently Asked Questions
- The RRT is awarded only after a TMC high cut score and a passing CSE; the TMC alone does not confer it.
- Standard first attempts cost USD 390 across both exams, or USD 350 with the one-time AARC member CSE discount.
- The TMC has 160 questions (140 scored) in three hours; the CSE has 22 problems (20 scored) in four hours.
- Live remote proctoring ended December 31, 2024, so testing happens at supervised PSI assessment centers.
What the RRT Credential Actually Is
RRT stands for Registered Respiratory Therapist. It is the advanced-level respiratory care credential awarded by the National Board for Respiratory Care (NBRC), and it signals that a therapist has passed both a broad knowledge examination and an interactive clinical simulation. If you are new to the terminology, our explainers on what RRT certification is and what RRT stands for cover the basics before you dig into exam mechanics.
This article focuses on the current route to the credential: the Therapist Multiple-Choice Examination (TMC) followed by the Clinical Simulation Examination (CSE). Because the NBRC is retiring this two-step structure on a published timeline, understanding exactly how it works today, and when it ends, matters more than usual.
The Two-Exam Route: TMC Then CSE
The most common misunderstanding about the 2026 RRT pathway is that it is a single appointment. It is not. The TMC and the CSE are separate examinations, taken at separate times, with separate fees, separate attempt limits, and separate score reports.
| Feature | TMC | CSE |
|---|---|---|
| Format | Multiple-choice | Interactive clinical-simulation problems |
| Total items | 160 (140 scored, 20 pretest) | 22 problems (20 scored, 2 pretest) |
| Time allowed | 3 hours | 4 hours |
| Fee (new / repeat) | USD 190 / USD 150 | USD 200 new or repeat |
| What a pass does | High cut score unlocks the CSE; low cut score leads to CRT | Passing completes the RRT requirement |
The TMC has two cut scores. Reaching the lower cut score earns the Certified Respiratory Therapist (CRT) credential, while reaching the higher cut score both earns CRT status and qualifies you to attempt the CSE. Only a passing CSE result awards the RRT. Current numeric cut scores are not something we can state with confidence, so treat any specific number you see circulating online with suspicion. For a deeper look at how scoring is structured, see our guide to the RRT passing score.
What the CSE feels like
The CSE is not a list of independent questions. Each of its 22 problems presents a patient scenario that can unfold across multiple sections, with choices at each step. The 2026 Candidate Handbook specifies one CSE score summed across the examination, rather than separate information-gathering and decision-making thresholds. In practice that means a strong performance in one part of a case can help offset a weaker one elsewhere, but you should still prepare for both skills, because both contribute to the single total.
Who Can Sit for the Exams
Standard eligibility requires that you are at least 18 years old and hold at least an associate degree from an eligible entry-into-practice respiratory program supported or accredited by CoARC. The CSE adds two further conditions: you must hold CRT status and have a qualifying high-cut TMC result.
There are conditional legacy CRT routes for therapists who do not fit the standard mold:
- Four years as a CRT plus 62 specified college hours.
- Two years as a CRT plus a qualifying respiratory associate degree.
- Two years as a CRT plus a non-respiratory bachelor's degree and 62 specified hours.
- A separately listed route for CSRT holders.
Those exceptions do not automatically carry into the 2027 pathway, so anyone relying on a legacy route should confirm their status with the NBRC rather than assume. Our RRT requirements breakdown walks through each prerequisite in more detail.
Fees, Registration, and Test-Day Rules
Here is the fee picture for a standard first attempt:
- TMC: USD 190 for a new candidate, USD 150 for a repeat.
- CSE: USD 200, whether new or repeat.
- Standard first attempts total USD 390 across both exams.
- Eligible AARC members can claim a one-time USD 40 discount on their first CSE through the prescribed application process, bringing the total to USD 350.
Those figures exclude education, preparation materials, membership dues, and state licensure, which is why the real cost of becoming an RRT is larger than the exam fees alone. Our RRT certification cost breakdown puts the full picture together.
Where and how you test
Testing takes place at supervised PSI assessment centers. Live remote proctoring ended on December 31, 2024, so at-home delivery is not a current option for initial examinations. The NBRC published its announcement at nbrc.org, and candidates should plan travel and scheduling around a physical test center.
Rules that affect your strategy
- Closed book: The only permitted aid is the virtual calculator supplied within the exam.
- Breaks cost time: Break time counts against your examination clock, so decide in advance whether you actually need one.
- Attempt limits: For each exam, three initial attempts are permitted without a waiting interval between them. Later attempts require 120 days between attempts.
For scheduling windows and deadlines, including the approaching TMC cutoff, see our RRT exam dates guide.
The Six Content Headings Across Both Exams
The NBRC publishes a separate Detailed Content Outline for each examination. The six headings below come from those two outlines: Domains 1 through 3 are the TMC objective headings, and Domains 4 through 6 are the CSE objective headings. Six is the count across two assessments; it is not an official combined six-domain exam, and no combined weights exist. The repeated headings are intentional, and one wording difference appears between the TMC and CSE versions of the equipment heading.
Domain 1: Patient Data (TMC)
This is the information-gathering foundation: reviewing patient records, interpreting findings, and recognizing what the data imply about a patient's respiratory status. The TMC scores 50 items here.
- Interpreting clinical findings and diagnostic results
- Recognizing which data points change your next step
- Evaluating the patient's response to therapy
Domain 2: Troubleshooting and Quality Control of Devices, and Infection Control (TMC)
Allocated 20 scored items, this is the smallest TMC section but one with very testable, concrete content.
- Diagnosing and resolving device and equipment problems
- Quality control practices for respiratory equipment
- Infection control procedures
Domain 3: Initiation and Modification of Interventions (TMC)
With 70 scored items, Interventions carries the largest TMC allocation. The exam expects you to choose, start, and adjust therapy appropriately, not merely recognize it.
- Selecting and starting appropriate interventions
- Modifying therapy when the patient's condition or data change
- Matching the intervention to the clinical picture
Domain 4: Patient Data (CSE)
The same heading reappears on the simulation, but here it is applied inside an unfolding case, where you decide which information to gather and when.
Domain 5: Troubleshooting and Quality Control of Equipment, and Infection Control (CSE)
Note the wording difference: the TMC heading says "Devices" while the CSE heading says "Equipment." The outlines treat these as distinct headings, so we preserve that distinction.
Domain 6: Initiation and Modification of Interventions (CSE)
In the simulation you are making and revising intervention decisions step by step as the patient changes.
We deliberately do not assign percentages to these headings. The only allocations established are the TMC scored item counts of 50, 20, and 70, and nothing supports a combined TMC/CSE weighting. For a fuller walkthrough, read our RRT exam domains guide.
How the CSE Assembles Its Cases
The 20 scored CSE problems are drawn from defined case-assembly groups. These describe the patient populations you should expect, not additional domains or weights.
| Case-assembly group | Scored problems |
|---|---|
| Adult Chronic Airways Disease | 7 |
| Adult Medical or Surgical | 5 |
| Adult Cardiovascular | 2 |
| Pediatric | 2 |
| Neonatal | 2 |
| Adult Trauma | 1 |
| Adult Neurological or Neuromuscular | 1 |
The practical lesson is that chronic airways disease and adult medical or surgical patients account for 12 of the 20 scored problems, so a candidate who is shaky on those populations is exposed. Pediatric and neonatal problems total four, which is small but not negligible, and candidates who work only with adults often underprepare here.
Key Takeaway
Match your simulation practice to the case mix. Spend the most time on adult chronic airways disease and adult medical or surgical scenarios, but do not skip neonatal and pediatric cases just because they appear less often.
Reading the 2025 Pass-Rate Data Correctly
The NBRC's 2025 Examinations in Review reports calendar-year results for each exam and cohort. These are the figures:
| Measure | New candidates | Repeat candidates |
|---|---|---|
| TMC high cut score | 68.2% | 29.4% |
| TMC low cut score | 78.5% | 48.9% |
| CSE | 63.6% | 53.0% |
The reported activity for the year was 11,086 TMC administrations, 9,004 CSE administrations, and 5,196 RRT credentials awarded.
What the data do show is consistent: repeat candidates fare worse on the TMC than first-time candidates, which reinforces the value of thorough first-attempt preparation. For more on interpreting these numbers, see our RRT pass rate analysis and our difficulty guide.
The 2027 Transition: What Changes and What Does Not
The two-exam route is on a countdown. The NBRC has announced a new Respiratory Therapy Examination, effective January 2027, that replaces the TMC-then-CSE sequence for new candidates. It is a separate future scope, and it should not be blended with the current TMC and CSE content outlines.
- Format: 185 multiple-choice questions (160 scored, 25 pretest) in four hours.
- Fees: USD 360 for new candidates, USD 300 for repeat candidates.
- Outcome: Lower and higher cut scores lead directly to the CRT and RRT respectively.
- Dates: Applications opened October 1, 2026; first examination availability is January 4, 2027.
Key dates for the current route
- TMC applications close December 15, 2026, and TMC testing ends December 31, 2026.
- The CSE remains available through December 31, 2027, but only for the eligible transition cohort.
- The CRT-to-registry admission policy expires December 31, 2026.
The central decision for candidates still on the current route is whether to finish the TMC before it ends or to wait for the new exam. That depends on your eligibility, your readiness, and your timeline, so check the latest guidance at the NBRC and review our scheduling guide before committing.
Keeping the Credential: The CMP
Earning the RRT is not the end of the NBRC's involvement. The credential is maintained through the five-year Credential Maintenance Program (CMP), with a published exemption for credentials earned before July 1, 2002. Practitioners can maintain through any of these routes:
- Assessment-based continuing education: zero, 15, or 30 Category I credits required, depending on how you perform on the assessment.
- Examination: passing the highest relevant examination during the final year of the maintenance cycle.
- Additional credential: earning another qualifying NBRC credential.
The CMP payment is USD 25 per payment year before 2027 and USD 30 beginning in 2027. Be aware that the CMP brochure shows a mix of older and newer fee versions in different places, but the live issuer FAQ confirms that the 2027 fee takes effect then. When in doubt, trust the current FAQ over the brochure.
Where Registered Respiratory Therapists Work
The RRT is the credential hospitals and critical-care employers tend to look for when staffing intensive and complex-care roles, because the CSE specifically tests clinical judgment across realistic patient scenarios. Typical employers include acute-care hospitals, adult and pediatric intensive care units, neonatal intensive care units, long-term acute care facilities, home respiratory care companies, and pulmonary rehabilitation programs.
That employer mix explains the structure of the exam. The case-assembly groups for chronic airways disease, trauma, cardiovascular, neurological, pediatric, and neonatal patients mirror the populations an RRT is expected to manage. If you want to explore how the credential translates into roles and earnings, our guides to RRT jobs, the RRT salary guide, and whether the certification is worth it go deeper on the career side.
Sequencing Your Preparation
Because the TMC and CSE test different skills, order your preparation around them rather than studying everything at once. The plan below assigns domains to weeks based on how each is weighted and how it feeds the next exam.
Domain 3 first: Interventions
- Largest TMC allocation at 70 scored items, so it earns the most early time
- Practice choosing and modifying therapy from patient data
Domain 1: Patient Data
- 50 scored items; strong data interpretation also sets up CSE information-gathering
- Work through case-style data sets
Domain 2: Devices, Quality Control, Infection Control
- 20 scored items with highly concrete, memorizable content
- Finish with a timed full-length TMC attempt
CSE preparation: Domains 4-6
- Practice multi-section simulations, prioritizing adult chronic airways and medical/surgical cases
- Add pediatric and neonatal scenarios
Whatever your timeline, build in at least one full timed run of each exam format, since the TMC's three hours and the CSE's four hours demand different pacing. For a complete method, see our RRT study guide, and keep our RRT cheat sheet handy for last-week review. When you are ready to test yourself, work through the questions on our RRT practice test site.
Key Takeaway
Prepare for two exams, not one. Finish and pass the TMC at the high cut score first, then shift to simulation-style practice, because the CSE rewards decision-making in context rather than recall alone.
Frequently Asked Questions
No. Reaching the TMC high cut score qualifies you to attempt the CSE, but the RRT is awarded only after you also pass the CSE. The lower TMC cut score leads to the CRT credential instead.
Not for initial examinations. Live remote proctoring ended on December 31, 2024, so testing takes place at supervised PSI assessment centers.
A standard first attempt costs USD 390: USD 190 for the TMC and USD 200 for the CSE. Eligible AARC members can use a one-time USD 40 first-CSE discount, bringing the total to USD 350. These figures exclude education, preparation, membership, and licensure.
For each exam, three initial attempts are permitted without a waiting interval. After that, later attempts require 120 days between attempts. Repeat fees are USD 150 for the TMC and USD 200 for the CSE.
Yes. The NBRC's new Respiratory Therapy Examination begins January 4, 2027, with 185 multiple-choice questions, four hours, and fees of USD 360 new or USD 300 repeat. TMC applications close December 15, 2026, and TMC testing ends December 31, 2026, with the CSE continuing through 2027 only for the eligible transition cohort.
Whether you are finishing the TMC before it retires or preparing for the new examination, the best preparation starts with understanding precisely what the NBRC will ask of you. Confirm every deadline with the issuer, build your plan around the real exam structure, and give yourself enough runway to make your first attempt count.