- The TMC Exam has 160 questions (140 scored, 20 unscored) with a 3-hour limit.
- Interventions is the heaviest domain, accounting for 70 of 140 scored items.
- New applicants pay USD 190; repeat applicants pay USD 150 through December 31, 2026.
- Meeting the high cut score can establish CSE eligibility if RRT admission requirements are met.
What CRT Certification Actually Is
Certified Respiratory Therapist (CRT) is a credential awarded by the National Board for Respiratory Care (NBRC) to candidates who pass the Therapist Multiple-Choice (TMC) Examination, administered via computer at PSI testing centers. This is the entry-level credential in respiratory care, distinct from the Registered Respiratory Therapist (RRT) designation, which requires meeting the TMC's high cut score plus additional admission requirements before sitting for the Clinical Simulation Examination (CSE).
If you're still sorting out terminology, our companion pieces on What Is CRT? and CRT Meaning walk through the basics before you dive into exam mechanics. This article assumes you already know you want the credential and need the operational details: format, domains, fees, and what happens after you pass.
TMC Exam Mechanics You Need to Know
The TMC Exam is a computer-based test delivered through PSI. Candidates answer 160 multiple-choice questions total: 140 are scored and 20 are unscored pretest items used to evaluate future questions. You won't know which items are which, so every question deserves full attention. You have a 3-hour limit to complete the exam, and an onscreen calculator is provided for any computation-based items. There is no penalty for guessing, which matters strategically - never leave a question blank.
This blueprint has been effective since January 2020 and runs through December 2026, meaning the content areas, question style, and scoring structure have been stable for years. That stability is good news for candidates: resources built against this blueprint remain reliable right up until the transition window closes.
Key Takeaway
Since guessing carries no penalty, always select an answer before time expires - an educated guess has better odds than a blank response, especially on the heavily weighted Interventions items.
The Three CRT Exam Domains
The TMC Exam is organized into three content domains, and the NBRC's official scored-item allocation is 50/20/70 across them. Understanding this weighting should directly shape how you allocate study time.
Domain 1: Patient Data
This domain covers gathering and interpreting clinical information you'd use to assess a patient's respiratory status - reviewing history, interpreting diagnostic results, and evaluating bedside data to inform care decisions.
- Accounts for 50 of the 140 scored items
- Requires comfort with interpreting labs, imaging, and monitoring data
Domain 2: Troubleshooting and Quality Control of Devices, and Infection Control
This domain tests your ability to identify equipment malfunctions, perform quality control checks, and apply infection control protocols across respiratory therapy devices.
- Accounts for 20 of the 140 scored items - the smallest share
- Covers ventilators, oxygen delivery systems, and airway equipment troubleshooting
Domain 3: Initiation and Modification of Interventions
This is the largest domain by far, covering the decisions a therapist makes to start, adjust, or discontinue respiratory treatments and support based on patient response.
- Accounts for 70 of the 140 scored items - half the entire scored exam
- Demands deep familiarity with therapeutic decision-making, not just recall
Because Interventions alone makes up half of your scored questions, candidates who under-prepare this domain put their entire result at risk. For a deeper breakdown of subtopics within each domain, see CRT Exam Domains 2026: Complete Guide to All 3 Content Areas.
Fees and Registration
The TMC Exam costs USD 190 for new applicants and USD 150 for repeat applicants. These fees apply through the current TMC testing window, which closes to new applications on December 15, 2026, with testing itself ending December 31, 2026.
Standard eligibility requires candidates to be at least 18 years old and to have graduated with at minimum an associate degree from a CoARC-supported or accredited entry-to-practice respiratory therapy program. If you're unsure whether your program qualifies or want the full eligibility breakdown, review CRT Requirements 2026: Eligibility, Prerequisites & How to Qualify before you register.
| Item | New Applicant | Repeat Applicant |
|---|---|---|
| TMC Exam fee (through Dec 31, 2026) | USD 190 | USD 150 |
| Question count | 160 (140 scored, 20 unscored) | |
| Time limit | 3 hours | |
For a complete look at every cost involved - application, retake, and ongoing maintenance fees - see CRT Certification Cost 2026: Complete Pricing Breakdown.
Cut Scores: CRT vs. CSE Eligibility
The TMC Exam uses two cut scores. Meeting the low cut score earns the CRT credential. Meeting the higher cut score does the same, but it also establishes eligibility to sit for the Clinical Simulation Examination (CSE) - the pathway toward RRT - provided the candidate also meets RRT admission requirements separately.
According to NBRC's 2025 data, low-cut pass rates were 78.5% for new candidates and 48.9% for repeat candidates. High-cut pass rates, which are naturally more difficult to reach, were 68.2% for new candidates and 29.4% for repeat candidates. These figures illustrate a meaningful gap between simply passing and passing well enough to open the RRT pathway.
For the exact numeric cut score requirements and how scoring is calculated, see CRT Passing Score 2026: Exactly What You Need to Pass. If you want a full statistical picture including how repeat attempts compare to first attempts, CRT Pass Rate 2026: What the Data Shows covers it in depth.
Keeping Your CRT Active
Earning the CRT is not a one-time event - the credential follows a five-year maintenance cycle. Within that cycle, the NBRC uses quarterly assessments to determine continuing education requirements: depending on performance, you may owe 0, 15, or 30 CE credits. There is also an eligible examination-based renewal route as an alternative path.
Maintenance carries a Continuing Competence Program (CMP) fee of USD 125 per five-year cycle, which is collected annually at USD 25 per year rather than as one lump sum. Budgeting for this ongoing cost is worth factoring into your overall certification planning, alongside the initial exam fee.
The 2027 Exam Transition
Candidates planning their timeline need to understand that the current TMC Exam blueprint is not permanent. Applications for the TMC Exam close on December 15, 2026, and testing under this format ends December 31, 2026. Starting January 4, 2027, a replacement Respiratory Therapy Examination takes over.
The new exam differs structurally: it includes 185 total questions (160 scored plus 25 pretest items), runs on a 4-hour time limit, and carries fees of USD 360 for new applicants and USD 300 for repeat applicants. It will continue to maintain separate CRT and RRT cut scores, similar in concept to the current dual cut-score structure, but the question bank, length, and fees are distinct from the 2026 exam - don't mix study materials or fee expectations between the two.
Key Takeaway
If you're eligible to test before the 2026 window closes, there's a strong practical incentive to do so under the current blueprint rather than wait for the longer, more expensive 2027 exam.
Track exact deadlines, blackout periods, and score release timing in CRT Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Who Hires CRTs
Respiratory therapy departments in hospitals, skilled nursing facilities, home care agencies, and pulmonary rehabilitation programs regularly staff CRT-credentialed practitioners, particularly in roles where RRT is not a strict prerequisite. Employers value the credential because it confirms a candidate has met CoARC-aligned educational standards and demonstrated competency across patient data interpretation, equipment management, and intervention decision-making - the exact three domains tested on the TMC.
If you're evaluating career direction, CRT Jobs outlines typical employment settings, and CRT Salary Guide 2026: Complete Earnings Analysis and Is the CRT Certification Worth It? Complete ROI Analysis 2026 help weigh the credential against the time and cost of earning it.
Building a Domain-Based Prep Plan
Rather than studying generically, structure your prep around the 50/20/70 scored-item split. Since Interventions represents half the scored exam, it deserves the largest and most sustained block of review time, followed by Patient Data, with Troubleshooting/Quality Control/Infection Control requiring focused but comparatively shorter review given its smaller share.
Patient Data Foundations
- Review diagnostic interpretation and bedside assessment concepts
- Practice questions isolated to this domain to gauge baseline strength
Troubleshooting, QC, and Infection Control
- Work through device malfunction scenarios and QC checklists
- Reinforce infection control protocols tied to equipment use
Interventions - Deep Focus
- Dedicate the longest stretch here since it's 70 of 140 scored items
- Work case-style questions requiring treatment initiation/modification decisions, not just recall
Full-Length Practice Under Timed Conditions
- Simulate the 3-hour, 160-question format
- Review missed items by domain to catch any remaining gaps
For a fuller walkthrough of pacing, resource selection, and common pitfalls by domain, see CRT Study Guide 2026: How to Pass on Your First Attempt and How Hard Is the CRT Exam? Complete Difficulty Guide 2026. When you're ready for timed practice, run full-length simulations on our practice test platform to get comfortable with the pacing before exam day.
Many candidates also keep a condensed reference handy during final review - the CRT Cheat Sheet 2026: One-Page Review of Must-Know Facts is built for exactly that last-mile review, and pairing it with timed drills on our platform helps confirm you can apply facts quickly under real time pressure.
Frequently Asked Questions
The TMC Exam has 160 total multiple-choice questions - 140 scored and 20 unscored pretest items - with a 3-hour time limit, administered via computer at PSI testing centers.
Meeting the low cut score earns the CRT credential. Meeting the higher cut score also establishes eligibility for the Clinical Simulation Examination toward RRT, provided you meet separate RRT admission requirements.
Through December 31, 2026, the TMC Exam fee is USD 190 for new applicants and USD 150 for repeat applicants.
Initiation and Modification of Interventions carries the heaviest weight at 70 of 140 scored items - half the exam - so it warrants the most study time, followed by Patient Data and then Troubleshooting/QC/Infection Control.
Yes. The current TMC Exam closes to applications December 15, 2026, and testing ends December 31, 2026. A replacement Respiratory Therapy Examination begins January 4, 2027, with 185 questions, a 4-hour limit, and different fees, while still maintaining separate CRT and RRT cut scores.