Credential Pathway: CRT to RRT

Mapping the Path from Student to RRT

The NBRC offers a two-tier credential ladder, and understanding exactly where each threshold sits prevents costly retakes. A change effective January 1, 2027 reshapes this ladder, so candidates testing in 2026 should know both the current system and what is coming.

Current Structure (Through December 31, 2026)

Tier 1 - Certified Respiratory Therapist (CRT)

• Earned by reaching the low cut score of 86 on the 140 scored TMC items
• Entry-level credential recognized for licensure in many states
• No CSE required

Tier 2 - Registered Respiratory Therapist (RRT)

• Requires the high cut score of 92 on the TMC
• Plus a passing performance on the Clinical Simulation Exam (CSE)
• Advanced credential preferred by most employers and required for many supervisory, ICU, and specialty roles

Prerequisites for Exam Eligibility

Credential Validity and Renewal

Credentials earned after July 1, 2002 are valid for 5 years and renew through the NBRC Continuing Competency Program (CCP). The standard renewal path requires 30 continuing education credits during the cycle (or completing assessments / earning a new credential). Letting a credential lapse can force re-examination, so track your renewal date from the day you certify.

Re-Examination Waiting Periods

There is no lifetime cap on attempts, but repeated failures should trigger a change in study strategy rather than a quick rebooking. Use the reduced $150 repeat fee wisely.

The 2027 Transition: One Combined Exam

Effective January 1, 2027, the NBRC retires the separate TMC and CSE and replaces them with a single Respiratory Therapy Examination (RTE):

The RTE blends breadth (knowledge across the field) with depth-of-judgment items that replace the old simulation format. Transition rule: candidates who pass the TMC at the high cut score on or before December 31, 2026 may still complete the CSE through December 31, 2027; otherwise they take the RTE. If you can reach the high cut score in 2026, doing so preserves the cheaper legacy pathway.

Career Outlook

Specialty Credentials After the RRT

These specialty exams require the RRT (or in some cases the CRT) as a prerequisite and are valuable for advancement into focused clinical roles.

Practical Planning Advice for the Transition Year

Because 2026 is the final full year of the legacy two-exam pathway, candidates graduating in 2026 face a genuine strategic decision. If you can realistically reach the high cut score (92) on the TMC before December 31, 2026, you preserve access to the cheaper CSE route (the CSE remains open to you through December 31, 2027) and the combined legacy fees are lower than the new $360 RTE fee. If you are not confident of clearing 92 in 2026, plan around the 2027 RTE instead: one sitting, 185 items, four hours, two cut scores in a single test.

Either way, your clinical knowledge base is identical — the blueprint of content does not change, only the packaging and pricing of the exam do. Do not let transition anxiety distract from mastering ventilation, ABGs, and oxygen therapy, which dominate every version of the exam.

Finally, keep your credential active once earned. The Continuing Competency Program runs on a five-year clock from your certification date, and missing the renewal can require you to re-test entirely. Set a calendar reminder the day you pass, log continuing education as you go rather than scrambling at year five, and you will never lose the credential you worked to earn.

Why Employers Reward the RRT

The gap between CRT and RRT is not merely a line on a resume. The RRT signals that a therapist cleared the high cut score and demonstrated patient-management judgment, which is why most acute-care hospitals, intensive care units, and supervisory tracks list the RRT as a requirement rather than a preference. Many employers offer a higher base wage or a differential for the RRT, and some hospital ladders make it a condition of promotion within a fixed window after hire. Pediatric, neonatal, and adult critical-care roles almost always assume the RRT plus a relevant specialty credential.

If you intend to work in any of those settings, plan from day one to reach the high cut score rather than settling for the CRT and retaking later, because a second TMC attempt costs both the $150 repeat fee and weeks of additional study time.