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United States · Credentialing exam

NBRC RRT: earning the Registered Respiratory Therapist credential

Through the end of 2026, the NBRC RRT takes two exams from the National Board for Respiratory Care (NBRC). You pass the Therapist Multiple-Choice (TMC) Examination at the high cut score, then the Clinical Simulation Examination (CSE). From January 4, 2027, the Respiratory Therapy (RT) Examination does both jobs: reach its high cut and you’re a Registered Respiratory Therapist (RRT) in one sitting.

  • 22Problems on the CSE, 20 of them scored
  • $200CSE fee, first attempt or repeat
  • December 31, 2027Last day the CSE is given
Where to study

Updated October 2026 · Written from official sources, listed at the bottom of this page

CRT or RRT: what’s the difference?

Both credentials start with the same multiple-choice exam. NBRC says RRTs show a higher level of proficiency, by scoring higher on that exam than a Certified Respiratory Therapist (CRT) needs to and by passing a further assessment of how they care for patients with different needs. You write either one after your name without periods, as in Chris Smith, RRT. The licensing role of both credentials is explained in the guide’s FAQ.

The RRT also opens NBRC’s specialty exams. You can apply for the Neonatal/Pediatric Specialty (NPS) exam once you’re an RRT, and for the Adult Critical Care Specialty (ACCS) exam after a year as one.

The NBRC NPS exam →The NBRC ACCS exam →

What the CSE is like

You get four hours for 22 patient problems. Twenty are scored and two are pretest problems, mixed in so you can’t spot them. Each problem opens with a short scenario about a patient, and the situation changes as you work through its sections.

Some sections tell you to choose only one option and others to select as many as you think are indicated. Once you choose an option, its result is shown and you can’t unselect it, and once you move on to the following section you can’t go back. A calculator is built into the software. Points from all your choices are added up across the whole exam and compared with one cut score, set by the exam committee’s decisions about which choices show minimal competence.

NBRC: CSE Detailed Content Outline (PDF) ↗

Who can take the CSE

You must be a CRT who passed the TMC at the high cut, or the older Therapist Written Examination by December 31, 2014. You must also meet one of these:

  • An associate degree or higher from an entry-into-practice respiratory therapy program accredited or supported by the Commission on Accreditation for Respiratory Care (CoARC)
  • At least four years as a CRT and 62 semester hours of college credit, including anatomy and physiology, chemistry, microbiology and mathematics
  • At least two years as a CRT and an associate degree from an accredited entry-level respiratory care program
  • At least two years as a CRT, a bachelor’s degree in another field and 62 semester hours of college credit with the same four subjects

The last three are NBRC’s CRT-to-Registry routes, which NBRC eliminates effective December 31, 2026. Each science and math course must appear by name on an official transcript. Courses challenged through the College Level Examination Program (CLEP) count if an accredited college awards credit for them. Courses from colleges outside the United States don’t count unless an accredited US college gives transfer credit.

NBRC: Registered Respiratory Therapist (RRT) ↗NBRC: CRT-to-Registry Evaluation Form (PDF) ↗

How do you earn the NBRC RRT from January 2027?

From January 4, 2027, you earn the RRT by reaching the high cut on the RT Examination. If you passed the TMC but not the CSE and hold an associate degree or higher from a CoARC entry-into-practice program, you can take the RT Examination. If you passed the TMC at the high cut before December 31, 2026, you can choose the CSE, open to you through December 31, 2027, or the RT Examination.

Don’t let your application lapse. NBRC keeps eligibility records for one year after you apply, and if yours are inactivated, a TMC or CSE pass toward the RRT is nullified. NBRC’s board says it means to keep the RRT standard where it is, not make it easier or harder. The RT Examination’s format and fee are on the guide.

NBRC: Examination Changes Coming in 2027, April 27, 2026 ↗The RT Examination and the TMC →The TMC and RT content outlines →

CSE pass rates and practice

CSE result202320242025
First attempt65.4%62.9%63.6%
Repeat attempt50.5%49.6%53.0%

NBRC gave 9,004 CSE exams in 2025 and awarded 5,196 RRT credentials that year. Its free CSE practice exam is a single problem that shows you the software. PSI sells two CSE Self-Assessment Examinations, Forms 2020 A and 2020 B, at $70 each in US dollars.

NBRC: 2025 Examinations in Review (PDF) ↗PSI: Clinical Simulation SAE (Form 2020 A) ↗NBRC’s practice exams and other study options →TMC cut scores and pass rates →
Sources: NBRC · PSI and 5 more. Checked October 2026.

Rules and fees can change, so check the official site before your test.

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