- CRT is the entry-level credential from the National Board for Respiratory Care, earned via the TMC Exam.
- The TMC has 160 questions (140 scored, 20 pretest) with a 3-hour limit, through December 31, 2026.
- Three domains are tested: Patient Data, Troubleshooting/Infection Control, and Interventions (70 of 140 scored items).
- New applicants pay USD 190; repeat applicants pay USD 150, via PSI testing centers.
What CRT Actually Means
CRT stands for Certified Respiratory Therapist, a credential issued by the National Board for Respiratory Care (NBRC). It is not a trademark, a display technology, or any other acronym you might stumble across in an unrelated search - on this site, and in the respiratory care profession, CRT refers specifically to the entry-level respiratory therapy certification earned by passing the Therapist Multiple-Choice (TMC) Examination.
The CRT credential exists to verify that a graduate of an accredited respiratory therapy program has the foundational knowledge and clinical judgment to practice safely. It's the first major milestone most respiratory therapists reach on their way into the field, and for many practitioners, it remains the credential they hold throughout their career. If you're just starting to research the term, our companion piece on CRT Meaning and the deeper dive at What Is CRT Certification? cover related angles on the same question.
The TMC Exam: Format and Structure
The TMC Examination is a computer-based test delivered through PSI. It consists of 160 multiple-choice questions, of which 140 are scored and 20 are unscored pretest items used by the NBRC to evaluate future questions. Because you can't tell which items are pretest and which count, the only sound strategy is to treat every question as if it counts.
Candidates are given a 3-hour time limit, which averages out to a little over a minute per question - generous by most standardized-exam benchmarks, but tight if you're second-guessing yourself on calculation-heavy items. The exam includes an onscreen calculator for questions involving ventilator math, oxygenation indices, and similar computations, and there is no penalty for guessing, so leaving a question blank is never the right move.
This exact structure - 160 questions, 3 hours, calculator available - applies to the current blueprint, which has been in effect since January 2020 and runs through December 2026. If you want a full breakdown of what "hard" actually means in the context of this format, see How Hard Is the CRT Exam? Complete Difficulty Guide 2026.
Key Takeaway
Every one of the 160 TMC questions should be answered - even a guess has better odds than a blank, since there's no penalty for incorrect answers.
The Three CRT Exam Domains
The TMC blueprint organizes content into three domains. Understanding how heavily each is weighted is essential for allocating your study time - a detail generic exam-prep advice can't tell you because it's specific to this credential's blueprint.
Domain 1: Patient Data
Covers interpreting patient history, physical exam findings, lab values, imaging, and monitoring data to determine a patient's respiratory status.
- Blood gas and pulmonary function interpretation
- Chest x-ray review and hemodynamic monitoring
- Recommending additional diagnostic data collection
Domain 2: Troubleshooting and Quality Control of Devices, and Infection Control
Focuses on equipment function, quality assurance, and infection prevention - the "keep the equipment and the environment safe" side of practice.
- Identifying and correcting equipment malfunctions
- Performing quality control checks on devices like ventilators and analyzers
- Applying infection control principles in the clinical setting
Domain 3: Initiation and Modification of Interventions
The largest domain by far, accounting for 70 of the 140 scored items - exactly half the scored exam. This domain tests your ability to select, start, and adjust respiratory treatments based on patient response.
- Oxygen and aerosol therapy initiation
- Mechanical ventilation setup and adjustment
- Airway management and emergency response actions
Because Domain 3 carries the heaviest scoring weight, it deserves the largest share of your review calendar. According to the official scored-item allocations, the three domains break down as 50, 20, and 70 items respectively out of 140 scored questions - meaning Interventions alone makes up half the scored exam. For an item-by-item walkthrough of subtopics within each domain, see CRT Exam Domains 2026: Complete Guide to All 3 Content Areas.
| Domain | Scored Items | Share of 140 Scored Questions |
|---|---|---|
| Patient Data | 50 | ~36% |
| Troubleshooting, QC & Infection Control | 20 | ~14% |
| Initiation and Modification of Interventions | 70 | 50% |
Registration, Fees, and Eligibility
To sit for the TMC Examination and earn CRT, you generally need to be at least 18 years old and a graduate of an associate-degree (or higher) respiratory therapy program that is accredited by, or supported by, the Commission on Accreditation for Respiratory Care (CoARC). If you're unsure whether your program qualifies or want the full checklist, CRT Requirements 2026: Eligibility, Prerequisites & How to Qualify lays out every prerequisite in detail.
The exam fee structure is straightforward:
- USD 190 for new applicants sitting for the TMC for the first time
- USD 150 for repeat applicants who need to retest
These fees are paid directly through the NBRC/PSI registration process. For a complete picture of what CRT actually costs once you factor in prep materials, potential retakes, and ongoing maintenance, check out CRT Certification Cost 2026: Complete Pricing Breakdown. And if you're mapping out when to apply, CRT Exam Dates 2026: Testing Windows, Deadlines & Scheduling covers the application and testing windows for this cycle.
How Scoring Works: CRT vs. CSE Eligibility
The TMC uses two cut scores. Meeting the low cut score earns you the CRT credential outright. Meeting the high cut score does something additional: it establishes eligibility for the Clinical Simulation Examination (CSE), the next step toward the Registered Respiratory Therapist (RRT) credential - but only when the candidate also meets RRT admission requirements separately. In other words, scoring high on the TMC doesn't automatically hand you RRT eligibility; it's one piece of a larger requirement set.
This two-tier scoring system is unique to the TMC and is worth understanding precisely before test day, since candidates sometimes assume any passing score opens the CSE door. It doesn't - the level of score matters. For a full explanation of exactly what score you need and how the two cut points are determined, see CRT Passing Score 2026: Exactly What You Need to Pass.
On pass-rate performance, NBRC's 2025 data showed low-cut (CRT) pass rates of 78.5% for new candidates and 48.9% for repeat candidates, while high-cut pass rates were 68.2% for new candidates and 29.4% for repeat candidates. These numbers illustrate a meaningful gap between first-attempt and repeat performance, underscoring the value of thorough first-attempt preparation. A deeper analysis of what these numbers mean for your own study plan is available in CRT Pass Rate 2026: What the Data Shows.
The 2027 Change You Need to Know About
It's important to keep the current and future exam formats separate in your mind, because they are genuinely different tests. The TMC Examination described throughout this article applies through December 31, 2026. Starting January 4, 2027, it will be replaced by a new Respiratory Therapy Examination with a different structure: 185 total questions (160 scored plus 25 pretest), a 4-hour time limit, and new fees of USD 360 for new applicants and USD 300 for repeat applicants. That replacement exam will still maintain separate cut scores for CRT and RRT outcomes, similar in concept to today's two-tier system.
If you're planning your testing timeline anywhere near that boundary, don't mix study materials from the two question banks - they cover overlapping content but are structured differently, and using the wrong prep resources could waste valuable study time.
Key Takeaway
If you can test before December 31, 2026, you'll sit for the 160-question TMC at the lower USD 190/150 fee structure. After that, the new 185-question exam and higher fees apply.
Who Hires Certified Respiratory Therapists
CRT holders work across the full spectrum of respiratory care settings. Common employers include:
- Hospital medical-surgical floors, emergency departments, and intensive care units
- Skilled nursing and long-term acute care facilities
- Home health and durable medical equipment companies
- Sleep diagnostic centers and pulmonary function labs
- Outpatient pulmonary rehabilitation clinics
Employers value the CRT credential because it confirms a graduate has met the accredited-program and examination standards set by the NBRC - a baseline that hospitals and staffing agencies often require before extending an offer. If you're evaluating whether this career path fits your goals, Is the CRT Certification Worth It? Complete ROI Analysis 2026 and CRT Salary Guide 2026: Complete Earnings Analysis both dig into the practical outcomes, while CRT Jobs surveys the range of roles available to credential holders.
Preparing for the TMC Exam
Because Domain 3 (Interventions) carries half of the scored questions, it makes sense to build your study calendar around it rather than splitting time evenly across all three domains. A practical approach: spend early weeks building foundational knowledge across Patient Data and Troubleshooting/Infection Control, then dedicate the largest, final block of your schedule to Interventions - ventilator initiation, oxygen therapy protocols, and modification decisions - since that's where the most points are concentrated.
Patient Data Foundations
- Blood gas and PFT interpretation drills
- Chest imaging and hemodynamic review
Troubleshooting & Infection Control
- Equipment malfunction scenarios
- QC procedures and infection prevention protocols
Interventions (Heaviest Weight)
- Ventilator setup and modification practice questions
- Oxygen/aerosol therapy and airway management scenarios
Full-Length Practice and Review
- Timed 160-question simulations under the 3-hour limit
- Review missed items across all three domains
Running full-length, timed practice sessions matters because the 3-hour limit and calculator interface are things you want to be comfortable with before test day, not discovering them for the first time in the testing center. Our CRT Study Guide 2026: How to Pass on Your First Attempt walks through a more detailed week-by-week plan, and the CRT Cheat Sheet 2026: One-Page Review of Must-Know Facts is a useful quick-reference during your final review days. You can also work through realistic scored practice questions modeled on the current blueprint at CRT Exam Prep.
Frequently Asked Questions
CRT stands for Certified Respiratory Therapist, the entry-level credential awarded by the National Board for Respiratory Care after passing the TMC Examination. For related terminology breakdowns, see What Does CRT Stand For? and What Does CRT Mean?.
The TMC Examination, which leads to CRT, contains 160 multiple-choice questions total - 140 scored and 20 unscored pretest items - administered under a 3-hour time limit through December 31, 2026.
CRT is earned by meeting the TMC's low cut score. Meeting the higher cut score establishes eligibility for the Clinical Simulation Examination toward RRT, but only when separate RRT admission requirements are also met.
New applicants pay USD 190 and repeat applicants pay USD 150 for the current TMC Examination. Fees change to USD 360/USD 300 under the replacement exam starting January 2027.