- The TMC Exam has 160 questions (140 scored, 20 unscored) with a 3-hour limit through December 31, 2026.
- Interventions (Domain 3) carries 70 of 140 scored items - half the entire exam.
- New applicants pay USD 190; repeat applicants pay USD 150.
- Meeting the high cut score opens CSE eligibility if RRT admission requirements are also met.
Exam Snapshot: The Numbers That Matter
If you only have five minutes before a study session, this is the section to reread. The Certified Respiratory Therapist (CRT) credential is awarded by the National Board for Respiratory Care (NBRC) after candidates pass the Therapist Multiple-Choice (TMC) Examination, delivered by PSI on computer. This page targets the current blueprint, which runs from January 2020 through December 2026.
- Format: 160 multiple-choice questions - 140 scored, 20 unscored pretest items you can't distinguish from scored ones
- Time limit: 3 hours
- Fee: USD 190 for new applicants, USD 150 for repeat applicants
- Tools: onscreen calculator provided; no penalty for guessing
- Outcome: meeting the low cut score earns CRT; meeting the high cut score also establishes CSE eligibility when RRT admission requirements are met
For a deeper walk-through of how these pieces fit together, the CRT Study Guide 2026: How to Pass on Your First Attempt expands on sequencing your prep around this exact structure.
The Three CRT Domains at a Glance
The TMC blueprint organizes content into three domains. Knowing the official scored-item allocation (50/20/70) tells you exactly where to spend your limited study hours.
Domain 1: Patient Data
Covers gathering and interpreting information needed to make clinical decisions - history, physical exam findings, lab values, imaging, and monitoring data.
- Roughly 50 of 140 scored items
- Requires comfort reading and interpreting diagnostic data quickly under time pressure
Domain 2: Troubleshooting and Quality Control of Devices, and Infection Control
Focuses on equipment function, malfunction recognition, calibration, and infection-control protocol application in respiratory care settings.
- Roughly 20 of 140 scored items
- Smallest domain by weight but frequently underprepared - don't skip it
Domain 3: Initiation and Modification of Interventions
The largest domain by far - 70 of 140 scored items, exactly half the scored exam. Covers selecting, starting, and adjusting therapeutic interventions based on patient response.
- Deserves the majority of your review time
- Includes oxygen therapy, airway management, ventilator initiation and adjustment, and therapeutic procedures
Because Domain 3 alone equals the other two combined, candidates who allocate study time evenly across all three domains are working against the blueprint, not with it. For a full content breakdown of each topic inside these three areas, see the CRT Exam Domains 2026: Complete Guide to All 3 Content Areas.
Key Takeaway
Spend roughly half your review time on Interventions (Domain 3), a quarter on Patient Data (Domain 1), and the remainder on Troubleshooting and Infection Control (Domain 2) - that mirrors the actual scored-item weighting.
Registration, Fees, and Deadlines
Budgeting and scheduling mistakes are entirely avoidable once you know the mechanics. Here's the compact version:
| Item | Detail |
|---|---|
| New applicant fee | USD 190 |
| Repeat applicant fee | USD 150 |
| Testing provider | PSI (computer-based) |
| 2026 application deadline | December 15, 2026 |
| 2026 testing window ends | December 31, 2026 |
Every dollar and deadline here applies specifically to the 2026 TMC cycle - the numbers change under the 2027 replacement exam, covered later in this article. For a complete accounting of every cost involved, including retake and maintenance fees, read the CRT Certification Cost 2026: Complete Pricing Breakdown. If you're still mapping out when to sit for the exam relative to graduation or work schedules, the CRT Exam Dates 2026: Testing Windows, Deadlines & Scheduling lays out the testing calendar in detail.
Scoring, Cut Scores, and What They Mean
The TMC uses two cut scores rather than a single pass/fail line. Meeting the low cut score earns the CRT credential outright. Meeting the high cut score does everything the low cut score does, plus it establishes eligibility for the Clinical Simulation Examination (CSE) - but only when the candidate also meets RRT admission requirements separately.
NBRC's 2025 data illustrates how much harder the high cut score is to reach than the low cut score:
| Cut Score | New Candidates | Repeat Candidates |
|---|---|---|
| Low cut (CRT) | 78.5% | 48.9% |
| High cut (CSE eligibility) | 68.2% | 29.4% |
Two patterns stand out: first-attempt candidates consistently outperform repeat candidates at both thresholds, and the gap between low-cut and high-cut success is substantial at every level. For the full statistical picture and what it implies about your own preparation, see the CRT Pass Rate 2026: What the Data Shows and the companion analysis at CRT Passing Score 2026: Exactly What You Need to Pass. If you're weighing how demanding this exam really is compared to what you've heard, How Hard Is the CRT Exam? Complete Difficulty Guide 2026 unpacks that question directly.
Eligibility Checklist
Before you can register, confirm you meet the standard entry requirements:
- Be at least 18 years old
- Have graduated with at least an associate degree from a CoARC-supported or accredited entry-to-practice respiratory therapy program
These two requirements are non-negotiable gatekeepers - there's no alternate pathway on this exam version. If you're a current student trying to figure out exactly when your program status qualifies you to apply, the CRT Requirements 2026: Eligibility, Prerequisites & How to Qualify article walks through common edge cases like partial program completion and transfer credits.
Keeping Your CRT: The Five-Year Cycle
Passing the TMC is not the finish line - credential maintenance runs on a five-year cycle with quarterly assessments. Depending on performance, you'll be required to complete 0, 15, or 30 continuing education (CE) credits, or you can pursue an eligible examination-based renewal route instead. There's also a Continued Competency Maintenance Program (CMP) fee of USD 125 per five-year cycle, typically collected as USD 25 annually.
Key Takeaway
Budget for the CMP fee (USD 25/year or USD 125 per cycle) as part of your long-term cost of holding the CRT credential, not just the one-time exam fee.
For candidates weighing whether the credential is worth pursuing given the ongoing maintenance commitment and market demand, Is the CRT Certification Worth It? Complete ROI Analysis 2026 and the CRT Salary Guide 2026: Complete Earnings Analysis both address the return side of the equation.
2026 vs. 2027: What's Changing
This distinction matters enormously and is a common source of confusion. Everything in this cheat sheet describes the TMC Examination as it exists through December 31, 2026. Starting January 4, 2027, a replacement exam - the Respiratory Therapy Examination - takes over.
| Feature | 2026 TMC Exam | 2027 Replacement Exam |
|---|---|---|
| Total questions | 160 (140 scored + 20 pretest) | 185 (160 scored + 25 pretest) |
| Time limit | 3 hours | 4 hours |
| New applicant fee | USD 190 | USD 360 |
| Repeat applicant fee | USD 150 | USD 300 |
| Cut scores | Separate low/high cuts | Separate CRT and RRT cut scores retained |
If you're applying near the end of 2026, keep the two question banks mentally separate - study materials, practice tests, and blueprint weightings built for the current TMC won't necessarily transfer to the 2027 version. Applications for the current cycle close December 15, 2026, with testing ending December 31, 2026.
Final Week Prep, Domain by Domain
In the last stretch before test day, resist the urge to restart broad review. Instead, use targeted passes that match the blueprint's actual weighting.
Interventions Deep Review
- Run timed question sets focused on oxygen therapy, airway management, and ventilator initiation/adjustment scenarios
- Since this domain is 70 of 140 scored items, any remaining weak spots here have outsized impact on your score
Patient Data Refresh
- Practice interpreting labs, imaging, and monitoring data under a timer to build speed for the 3-hour limit
- Review how data points connect to intervention decisions, since the domains overlap conceptually
Troubleshooting, Infection Control, and Logistics
- Close remaining gaps in equipment malfunction and infection-control protocol questions
- Confirm PSI testing center details, ID requirements, and arrival time so exam-day logistics aren't a surprise
Working through full-length, timed simulations on a CRT-focused practice test platform during this window helps you get comfortable with the onscreen calculator and pacing before the real 3-hour clock starts.
Frequently Asked Questions
The TMC Examination has 160 multiple-choice questions - 140 scored plus 20 unscored pretest items - with a 3-hour time limit, through December 31, 2026.
Domain 3, Initiation and Modification of Interventions, carries 70 of the 140 scored items - half the entire scored exam - making it the highest-priority domain for review time.
Meeting the high cut score earns CRT and also establishes CSE eligibility, but only when the candidate separately meets RRT admission requirements.
New applicants pay USD 190; repeat applicants pay USD 150. This applies to the current TMC cycle running through December 31, 2026.
Yes - CRT follows a five-year maintenance cycle involving quarterly assessments requiring 0, 15, or 30 CE credits based on performance (or an eligible exam-based renewal), plus a CMP fee of USD 125 per cycle, usually paid as USD 25 annually.