United States · Credentialing examWhat does the NBRC ACCS exam cover?
The August 2026 outline splits the 150 scored questions into two areas. The other 20 are pretest questions.
| Area | Items |
|---|---|
| Respiratory critical care | 80 |
| General critical care | 70 |
The general critical care area includes planning for disasters, pandemics and mass casualty events. NBRC also uses two secondary specifications: one for questions that make you think through the ethics of a situation, and one by patient condition, so no form leans too hard on one kind of patient.
Fees, retakes and practice
The ACCS exam costs $300 for a first attempt and $250 for a repeat. After two attempts you wait at least 180 days between tries.
NBRC’s free ACCS practice exam has 50 items, a third of the real length, covering the content areas and question types in the same proportions as the real exam. It was written by the same committee. PSI sells an ACCS Self-Assessment Examination, Form 2026, for $60 in US dollars.
ACCS pass rates
| ACCS result | 2023 | 2024 | 2025 |
|---|---|---|---|
| First attempt | 65.4% | 61.0% | 57% |
| Repeat attempt | 45.6% | 36.9% | 34.0% |
NBRC gave 1,303 ACCS exams in 2025 and awarded 645 RRT-ACCS credentials that year. Its report gives the 2025 first-attempt rate as a whole number.
Who the RRT-ACCS is for
NBRC built the exam from a job analysis, surveying several thousand people who care for adult critical care patients, and says it’s more about clinical situations than the technical side of respiratory care. The program is supported by the American Association for Respiratory Care (AARC), the American College of Chest Physicians, the American Society of Anesthesiologists and the American Thoracic Society. Like your RRT, the RRT-ACCS lasts five years and is kept through NBRC’s Credential Maintenance Program, with assessments and any continuing education (CE) in adult critical care.
Sources: NBRC · PSI and 4 more. Checked October 2026.
- NBRC: Adult Critical Care Specialty (ACCS) ↗
- NBRC: ACCS Detailed Content Outline, effective August 2026 (PDF) ↗
- NBRC: ACCS Exam FAQs ↗
- NBRC: Candidate Handbook, revised September 3, 2026 (PDF) ↗
- NBRC: 2025 Examinations in Review (PDF) ↗
- PSI: NBRC Self-Assessment Examinations ↗
Rules and fees can change, so check the official site before your test.
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