NBRC exam change · January 2027
The 2027 RT Exam, explained.
In January 2027 the NBRC's Respiratory Therapy Examination replaces the TMC and CSE. Here's what changes, the dates that matter, and which exam you should take — sourced from the NBRC.
- 185
- 4 hrs
- 2
- 2
What's changing
Two exams become one.
One exam replaces two
The RT Exam replaces the TMC and the Clinical Simulation Exam (CSE). The separate branching simulation goes away.
Two cut scores, two credentials
Reach the low cut score and you earn the CRT. Reach the high cut score and you earn the RRT — on the same exam.
Clinical judgment, in multiple choice
60 scored items assess depth of clinical judgment: choosing what to assess, and deciding what to add, change or stop.
185 items in 4 hours
160 scored items plus 25 unscored pretest items, built from the NBRC's 2027 Detailed Content Outline.
The TMC and its outline still apply
The current TMC Detailed Content Outline is effective January 2020 through December 31, 2026.
Pass the TMC at the high cut to keep the CSE
Candidates who pass the TMC at the high cut score before December 31, 2026 keep the CSE route open.
The RT Exam begins
One multiple-choice exam with a CRT cut score and an RRT cut score replaces the TMC and CSE.
Last chance to complete the CSE
Those TMC high-cut candidates have until December 31, 2027 to complete the CSE — or they can take the RT Exam instead.
Side by side
TMC + CSE vs. the RT Exam.
| Topic | TMC + CSE through 2026 | RT Exam from January 2027 |
|---|---|---|
| Exams | Two: the TMC, then the CSE | One: the RT Exam |
| Items | TMC: 160 (140 scored). CSE: 22 problems (20 scored) | 185 (160 scored, 25 pretest) |
| Testing time | TMC 3 hours + CSE 4 hours | 4 hours |
| Clinical judgment | A separate branching simulation exam (CSE) | A 60-item Depth of Clinical Judgment portion, in multiple choice |
| CRT | TMC low cut score | RT Exam low cut score |
| RRT | TMC high cut score, then pass the CSE | RT Exam high cut score |
| Fees (new / repeat) | TMC $190 / $150; CSE $200 | $360 / $300 |
Sources: NBRC RRT examinations · NBRC 2027 changes. Fees and details can change — check nbrc.org before you apply.
Decision helper
Which exam should I take?
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A summary of the NBRC's published changes, not official guidance. Your eligibility and dates are set by the NBRC.
The 2027 outline
16 content areas, weighted.
I. Patient Data
25 items- Evaluate Data in the Patient Record3
- Perform Clinical Assessment6
- Perform Procedures to Gather Clinical Information5
- Evaluate Procedure Results7
- Recommend Diagnostic Procedures4
II. Management of Devices and Patient Safety Procedures
25 items- Troubleshoot Devices During and After Assembling19
- Ensure Infection Prevention or Control, Safety, and Performance of Quality Assurance Procedures6
III. Initiation and Modification of Interventions
50 items- Maintain a Patent Airway Including the Care of Artificial Airways6
- Perform Airway Clearance and Lung Expansion Techniques4
- Support Oxygenation and Ventilation10
- Administer Medications and Specialty Gases3
- Make or Recommend Changes to the Respiratory Care Plan10
- Use Evidence-Based Practice3
- Provide Respiratory Care in High-Risk Situations5
- Assist a Physician or Provider in Performing Procedures4
- Interact with Team Members, Patients, and Families5
Built around patient conditions — chronic lung disease, trauma, cardiovascular, neuromuscular, medical, peri-operative, pediatric and neonatal.
- 20
- 40
- 46
- 14
Go deeper
Three guides to the new exam.
How RRT Academy helps
Practice the judgment, not just the facts.
Where we are with 2027 content. Our question bank was written to the TMC outline. We've mapped it onto the 16 RT Exam content areas, and new questions written to the 2027 outline are in clinical review. We haven't verified full coverage of the 2027 outline, and we'll say so here when we have.
Testing in 2027?
Get the 2027 RT Exam study plan.
A week-by-week plan built on the 2027 outline's weights. Join the list and we'll email it to you when it's published, along with RT Exam updates as the NBRC releases them.
Questions
RT Exam FAQ.
When does the NBRC RT Exam start?
The NBRC says the change will be implemented in January 2027. The TMC Detailed Content Outline is effective through December 31, 2026.
How many questions are on the RT Exam, and how long is it?
185 multiple-choice items — 160 scored and 25 pretest — over 4 hours. The scored items are split into a Breadth of Knowledge portion (100 items) and a Depth of Clinical Judgment portion (60 items).
How do I earn the CRT or the RRT on the new exam?
The RT Exam has two cut scores. Achieving the low cut score earns the CRT credential; achieving the high cut score earns the RRT credential.
Is the CSE going away?
Yes — the RT Exam replaces the TMC and CSE. If you pass the TMC at the high cut score before December 31, 2026, the NBRC says you have until December 31, 2027 to complete the CSE, or you can take the RT Exam and pass at the high cut score instead.
How much does the RT Exam cost?
The NBRC lists $360 for new applicants and $300 for repeat applicants.
What is the Depth of Clinical Judgment portion?
60 items built around patient conditions. Per the outline, 20 are information gathering (choose what to assess or interpret information) and 40 are decision making (decide what to add, modify, continue or discontinue); 46 are set in a hospital and 14 outside one.
Does RRT Academy cover the 2027 RT Exam?
Partly, and we won't overstate it. Our question bank was written to the TMC outline, which overlaps heavily with the RT Exam's content areas, and new questions written to the 2027 outline are going through clinical review. We have not verified full coverage of the 2027 outline yet. The simulators and clinical-judgment cases train skills both exams test.
Is RRT Academy affiliated with the NBRC?
No. RRT Academy is an independent study resource, not affiliated with, sponsored by or endorsed by the National Board for Respiratory Care. Always confirm dates, fees and eligibility on nbrc.org.
Find out where you stand.
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RRT Academy is independent and not affiliated with, sponsored by or endorsed by the NBRC. Programs preparing a cohort for 2027? See RRT Academy for programs.