What Is CRT Certification?

What Is CRT Certification, Exactly?

Certified Respiratory Therapist (CRT) is a credential awarded by the National Board for Respiratory Care (NBRC) to candidates who meet the low cut score on the Therapist Multiple-Choice (TMC) Examination. It's the entry-level credential in respiratory therapy - the first professional milestone after finishing an accredited respiratory therapy program, and the credential most graduates need before they can legally practice and pursue licensure in most states.

If you're only asking what is CRT or trying to pin down the CRT meaning in a healthcare context, this is it: a nationally recognized certification proving you can safely assess patients, operate and troubleshoot respiratory equipment, and initiate or adjust respiratory care interventions under the TMC blueprint that runs from January 2020 through December 2026.

Who Runs the Exam and How It's Delivered

The NBRC develops and owns the TMC Examination content; PSI is the testing provider that delivers the exam at computer-based test centers. The exam format is straightforward but unforgiving on timing:

• 160 total multiple-choice questions - 140 scored, 20 unscored pretest items you can't distinguish from scored ones
• 3-hour time limit for the full test
• Onscreen calculator provided for calculation-based items
• No penalty for guessing - every question should get an answer before time runs out

Because pretest items are mixed in unlabeled, candidates should treat every question as if it counts. For a deeper breakdown of how difficult the actual test experience is, see our CRT exam difficulty guide, and for the specific score you need to clear, check the CRT passing score breakdown.

The Three TMC Exam Domains

All 140 scored questions on the TMC fall into three content domains, with a fixed scored-item allocation of 50/20/70. That weighting tells you exactly where to invest study time.

For a full walkthrough of every subtopic within each domain, read the complete CRT exam domains guide. Because Domain 3 alone makes up half the scored test, it deserves the largest share of your review schedule.

Who Can Sit for the TMC Exam

Eligibility for the TMC is defined narrowly by the NBRC:

• Be at least 18 years old
• Graduate with at least an associate degree from a CoARC-supported or accredited entry-to-practice respiratory therapy program

There's no separate work-experience substitute - the accredited program requirement is fixed. If you're mapping out your path before enrolling or applying, our detailed CRT requirements page covers documentation, program verification, and application timing in full.

CRT vs. CSE Eligibility: How Cut Scores Work

The TMC uses a dual cut-score system, which is one of the most misunderstood parts of the credential:

• Low cut score: meeting this earns the CRT credential outright.
• High cut score: meeting this also establishes eligibility for the Clinical Simulation Examination (CSE) - the next step toward the RRT credential - provided the candidate also meets RRT admission requirements.

In other words, one exam attempt can do double duty: pass at the low cut and you're a CRT; pass at the high cut with the right academic background and you're positioned to move straight toward advanced-practice credentialing. According to the NBRC's 2025 data, low-cut pass rates were 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. That gap between low-cut and high-cut success rates is a useful reality check when setting your target score. See the full numbers and what they mean for your prep in our CRT pass rate analysis.

Fees, Registration, and Timing

Through December 31, 2026, the TMC Examination fee structure is:

Applications for this version of the exam close December 15, 2026, with testing ending December 31, 2026 - after that, the exam changes entirely (more on that below). If you're budgeting for the full path to certification, including retakes and continuing education, our CRT certification cost breakdown lays out every line item, and the CRT exam dates and deadlines guide covers scheduling windows in detail.

Keeping the Credential Active

CRT certification isn't a one-and-done credential. The NBRC runs credentials on a five-year maintenance cycle:

• Quarterly assessments determine whether you need 0, 15, or 30 continuing education (CE) credits, depending on performance
• Alternatively, an eligible examination-based renewal route is available
• The Continuing Maintenance Program (CMP) fee is USD 125 per five-year cycle, typically collected as USD 25 annually

Building this into your long-term plan matters as much as passing the initial exam - a lapsed credential can affect employment and state licensure standing.

What Changes in 2027

This is a critical detail for anyone planning their exam date. The TMC Examination, as described above, is only valid through the end of 2026. Starting January 4, 2027, it's replaced by a new Respiratory Therapy Examination with a different structure:

The new exam retains separate CRT and RRT cut scores, so the dual-purpose structure survives the transition - but everything else about format, length, and cost is different. Keep the 2026 and 2027 question banks and blueprints mentally separate; content prepared for one is not interchangeable with the other. Candidates eligible before the cutoff should factor this hard deadline into their CRT study guide and prep timeline.

Who Hires CRTs

CRT-credentialed therapists work across the settings where respiratory care is delivered: hospital medical-surgical and intensive care units, emergency departments, neonatal and pediatric units, skilled nursing and long-term acute care facilities, home care and durable medical equipment companies, and sleep diagnostic centers. Many employers list CRT as the minimum credential for entry-level respiratory therapist roles, with RRT often preferred or required for more advanced positions. If you're weighing career paths and pay expectations, our CRT salary guide and ROI analysis of CRT certification break down what the credential actually opens up, and our CRT jobs overview surveys the range of settings hiring managers pull from.

Mapping a Study Plan to the Domains

Because Domain 3 (Initiation and Modification of Interventions) carries half the scored questions, your weekly plan should weight accordingly rather than splitting time evenly across all three domains.

Timed practice matters as much as content review, since the exam gives you 3 hours for 160 questions with no penalty for guessing - pacing failures cost more candidates points than knowledge gaps do. You can build that pacing on our CRT practice test platform, and cross-reference weak areas against the CRT cheat sheet for quick, must-know facts before test day.

Frequently Asked Questions