The short answer: the NBRC is retiring the two-step TMC + CSE pathway and replacing it with a single examination — the Respiratory Therapy Examination. The TMC’s last day is December 31, 2026, and the first administrations of the new exam are January 4, 2027. One exam, one total score, two cut scores: reach the low cut and you earn the CRT; reach the high cut and you earn the RRT. This page lays out the full transition — dates, structure, fees, and the one grandfathered exception.
What is replacing the TMC?
For decades, the route ran in two steps: pass the Therapist Multiple-Choice Examination (TMC) at the high cut score, then pass the Clinical Simulation Examination (CSE) to earn the RRT. The NBRC’s Board of Trustees voted in April 2022 to replace that pathway with a single multiple-choice examination. The Respiratory Therapy Examination folds both steps into one test, built on a new Detailed Content Outline effective January 2027 — there is no separate simulation exam in the new system.
How is the new Respiratory Therapy Examination structured?
| Feature | New Respiratory Therapy Examination |
|---|---|
| Questions | 185 administered — 160 scored + 25 pretest |
| Portions | Breadth of Knowledge (100 scored) + Depth of Clinical Judgment (60 scored) |
| Time limit | 4 hours |
| Scoring | One total score out of 160 — pass/fail is not decided per portion |
| Credentials | Low cut score → CRT · High cut score → RRT |
| Fee | $360 new applicant / $300 repeat |
| Results | Delivered the same day as testing, from the first administrations |
One honest gap: the NBRC has not published the numeric cut scores for the new exam. A 2026 cut-score study transfers the existing CRT/RRT standards onto the new scale, and the NBRC’s stated intent is to maintain those standards — not raise or lower them. Any preparation product quoting an exact passing number for the new exam is guessing, and ours does not.
When does the TMC go away?
- December 15, 2026 — last day to apply for the TMC.
- December 31, 2026 — last day to take the TMC; the TMC retires. The CRT-to-Registry Admission Policy is also eliminated on this date.
- January 1, 2027 — the new system takes effect. Eligibility requires at least an associate degree from a CoARC-accredited or CoARC-supported entry-into-practice respiratory therapy program.
- January 4, 2027 — first administrations of the Respiratory Therapy Examination. (January 1 is the policy date; testing begins January 4.)
What happens to the CSE?
The CSE is the one piece that lingers. Candidates who passed the TMC at the high cut score on or before December 31, 2026 may still take the CSE through December 31, 2027, when it retires for good. There is a fork in that road: those candidates may instead elect the new Respiratory Therapy Examination — but once a candidate applies for the new exam, they are no longer eligible for the CSE. If you are in that cohort, decide deliberately; the choice cannot be undone.
What does the change cost?
The new exam fee is $360 for a new applicant and $300 for a repeat — a single fee for a single exam. The old pathway to the RRT cost $390 in examination fees on a first attempt (TMC plus CSE). The credential now costs less to reach and takes one examination instead of two.
How PassProfessor handles the change
Our NBRC Respiratory Therapy Exam Prep bank — 2,000 practice questions — is built to the new exam’s January 2027 Detailed Content Outline, mirroring the real form: 100 breadth questions and 60 depth questions assembled the way the NBRC assembles them. It is a bank for the exam that exists from January 4, 2027 — not a relabeled TMC product. Our NBRC exam guide covers eligibility and the application process in full.
Start with the free sample
Every PassProfessor program opens with free sample questions. Start the Respiratory Therapy free sample and get a feel for the new exam’s depth-portion scenarios before your date arrives.
More exam changes to know about
Exams change on announced dates, and preparation should change with them. PassProfessor tracks the announced changes across the catalog: