- RRT requires the TMC high cut score and then a passing CSE; the TMC alone does not award the credential.
- TMC is 160 questions in three hours; CSE is 22 simulation problems in four hours.
- Standard first attempts cost USD 390 total, or USD 350 with the one-time AARC member CSE discount.
- Live remote proctoring ended December 31, 2024; testing happens at supervised PSI assessment centers.
The Two-Exam Route at a Glance
The Registered Respiratory Therapist credential is awarded by the National Board for Respiratory Care (NBRC). Under the current 2026 route, you earn it by clearing two separate examinations in order: the Therapist Multiple-Choice Examination (TMC) at the high cut score, then the Clinical Simulation Examination (CSE). Treating these as one long appointment is the most common misunderstanding, so keep them mentally separate. If you are still orienting yourself on the credential itself, start with What Is RRT Certification?, then come back here for the fast-review version.
| 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 attempt | USD 190 | USD 200 |
| Fee, repeat attempt | USD 150 | USD 200 |
| Prerequisite | Eligibility approval | CRT status plus a qualifying TMC high-cut result |
Numbers to Memorize
These are the figures worth committing to memory before exam week. Everything below comes from NBRC-published information as checked on October 14, 2026.
- TMC: 160 multiple-choice questions, of which 140 are scored and 20 are unscored pretest items. You cannot tell which are which, so treat every question as live.
- CSE: 22 problems, of which 20 are scored and two are pretest. Each problem can contain multiple sections and multiple choices within them.
- CSE scoring: The 2026 Candidate Handbook specifies a single CSE score summed across the examination. It does not describe separate information-gathering and decision-making pass thresholds, so do not study as if those older sub-thresholds exist.
- Fees: TMC is USD 190 new or USD 150 repeat. CSE is USD 200 whether new or repeat. Eligible AARC members can get a one-time USD 40 discount on their first CSE through the prescribed application process.
- Fee total: A standard first-attempt run is USD 390, or USD 350 with the AARC discount. That excludes education, preparation materials, membership dues, and state licensure. The full breakdown lives in RRT Certification Cost 2026.
Eligibility and Retake Rules
Standard route
The typical candidate is at least 18 years old and holds at least an associate degree from an eligible CoARC-supported or accredited entry-into-practice respiratory program. To sit the CSE you also need CRT status and a qualifying high-cut TMC result. A fuller walkthrough is in RRT Requirements 2026.
Conditional legacy CRT routes
NBRC lists several conditional routes for existing CRTs:
- 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 CSRT route to RRT.
Attempt limits
For each examination, three initial attempts are permitted without the subsequent-attempt waiting interval. After that, later attempts require 120 days between attempts. Repeat TMC takers pay the lower USD 150 fee; repeat CSE takers pay the same USD 200.
Six Domain Headings, Two Assessments
The six domains you will see in outlines are not a single combined six-part exam. Domains 1 through 3 are the official TMC exam-objective headings, and Domains 4 through 6 are the official CSE headings. The repeated names are intentional, and so is the small wording difference between "Devices" on the TMC side and "Equipment" on the CSE side. Because the two assessments publish separate outlines, no combined TMC/CSE domain weights exist, and none should be invented. A deeper walkthrough is in RRT Exam Domains 2026.
Domain 1: Patient Data (TMC, 50 scored items)
Questions on gathering and evaluating clinical information before any decision is made.
- Reviewing the patient record, history, and current orders
- Interpreting bedside assessment findings and monitoring data
- Reading blood gases, pulmonary function results, and imaging
- Recognizing which result changes the plan of care
Domain 2: Troubleshooting and Quality Control of Devices, and Infection Control (TMC, 20 scored items)
The smallest TMC allocation, but easy points if you know the logic of device checks.
- Diagnosing ventilator and monitoring-device alarms and malfunctions
- Performing and interpreting quality-control checks on analyzers and equipment
- Applying infection-control practices to devices, circuits, and procedures
Domain 3: Initiation and Modification of Interventions (TMC, 70 scored items)
The biggest block of the TMC by far, and the one that rewards clinical judgment.
- Choosing and starting airway clearance, oxygen, aerosol, and ventilatory interventions
- Adjusting therapy in response to patient status and data
- Recommending changes in medications, ventilator settings, or support level
- Handling emergencies and weaning decisions
Key Takeaway
The TMC scored allocations are 50, 20, and 70 items across Domains 1, 2, and 3. Interventions carries the largest share, so weak intervention reasoning is the costliest gap to leave open. No percentage weights are published in the sources used here, so rely on the item counts.
Domains 4, 5, and 6 repeat those same headings for the CSE: Patient Data, Troubleshooting and Quality Control of Equipment, and Infection Control, and Initiation and Modification of Interventions. On the CSE, these themes surface inside branching patient scenarios rather than as standalone questions.
How the CSE Assembles Its Cases
The CSE's 20 scored problems are drawn from defined assembly groups. These are case-assembly groups, not extra domains and not editorial weights:
| Case 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 |
Chronic airways disease alone accounts for seven of the 20 scored problems, so COPD, asthma, and related exacerbation management deserve outsized practice time. Adult medical or surgical cases come next at five. Pediatric and neonatal cases total four together, a small slice that still shows up every time, and they involve different equipment, doses, and physiology than adult care, so do not skip them.
Because one problem can contain several sections with several choices each, CSE preparation is about pattern recognition and sequencing: what to assess first, what to do for an unstable patient, and when a recommendation is appropriate. Working through simulation-style practice in the RRT practice test helps build that habit. Getting oriented on the difficulty curve is covered in How Hard Is the RRT Exam?
2025 Pass Data in Context
NBRC's 2025 Examinations in Review reports calendar-2025 pass rates by exam and cohort:
| Assessment | New candidates | Repeat candidates |
|---|---|---|
| TMC, high cut | 68.2% | 29.4% |
| TMC, low cut | 78.5% | 48.9% |
| CSE | 63.6% | 53.0% |
Study Order Built Around the Exam Structure
Because the TMC must be cleared at the high cut before the CSE, sequence your preparation to match. One compact way to do it, weighted by the published item counts:
Interventions first (Domain 3)
- It holds 70 of the 140 scored TMC items, so it earns the earliest and longest block
- Cover oxygen therapy, aerosol delivery, airway clearance, and ventilator management
Patient Data (Domain 1)
- Drill blood gas interpretation, PFT patterns, and imaging findings
- Practice deciding which finding should change the plan
Troubleshooting, quality control, infection control (Domain 2)
- Review alarm logic, analyzer quality control, and circuit and device infection-control rules
CSE case work
- Spend most time on chronic airways and adult medical or surgical scenarios
- Add pediatric and neonatal cases deliberately
For a fuller plan, see the RRT study guide.
Test-Day Rules
- Location: Examinations are delivered at supervised PSI assessment centers. Live remote proctoring ended December 31, 2024, so initial at-home examination delivery is not a current option.
- Closed book: No reference materials. The only calculator allowed is the virtual calculator supplied in the testing software, so practice with an on-screen calculator beforehand.
- Breaks: Break time counts against examination time, so the clock keeps running when you step away. Use breaks sparingly.
- Pacing: Three hours for 160 TMC questions leaves a little over a minute per question. Four hours for 22 CSE problems demands steady movement through multi-part scenarios.
Key Takeaway
Unscored pretest items are mixed in on both exams and look identical to scored ones. Never spend extra time trying to guess which question "doesn't count."
Deadlines and the 2027 Transition
The current TMC/CSE route is winding down, so timing is critical. A calendar guide is available in RRT Exam Dates 2026. Key points:
- 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.
- NBRC wording about achieving the TMC high cut "prior to December 31, 2026" conflicts with the announced final testing date. If you plan to test on December 31, confirm with NBRC whether that result will qualify you.
What replaces it
A single Respiratory Therapy Examination takes effect January 2027: 185 multiple-choice questions (160 scored, 25 pretest) in four hours. Fees are USD 360 new and USD 300 repeat, and lower and higher cut scores lead directly to CRT and RRT respectively. Applications opened October 1, 2026, and first examination availability is January 4, 2027. That exam has its own outline, so do not blend its content into the TMC and CSE domains described above. Transition details are published at nbrc.org/resources.
After You Earn the Credential
The RRT is maintained through NBRC's five-year Credential Maintenance Program (CMP). A published exemption exists for credentials earned before July 1, 2002. Maintenance routes include:
- Assessment-based continuing education requiring zero, 15, or 30 Category I credits depending on your performance.
- Passing the highest relevant examination during the final year of the cycle.
- Earning an additional qualifying NBRC credential.
The CMP payment is USD 25 per payment year before 2027 and USD 30 beginning in 2027. The CMP brochure mixes old and new fee versions in places, but NBRC's live FAQ confirms the 2027 effective date. As for the career payoff, RRT jobs, the RRT salary guide, and the ROI analysis cover the questions that tend to come next.
FAQ
No. Under the current 2026 route, you must reach the TMC high cut score and then pass the CSE. The TMC alone does not award the RRT.
No. Live remote proctoring ended December 31, 2024, and initial at-home examination delivery is not a current option. Testing takes place at supervised PSI assessment centers.
A standard first-attempt run is USD 390 (USD 190 for the TMC plus USD 200 for the CSE), or USD 350 if you qualify for the one-time USD 40 AARC member discount on your first CSE. Education, preparation, membership, and licensure are extra.
No. They are separate examinations with separate fees, formats, and time limits: 160 multiple-choice questions in three hours, and 22 simulation problems in four hours.
Three initial attempts per examination are allowed without a waiting interval. Later attempts require 120 days between attempts.
To turn this one-page review into working knowledge, test yourself with the full-length questions in the RRT Exam Prep practice tests, and revisit the RRT cheat sheet before exam day to lock in the numbers.