Last updated: July 2, 2026 · Reviewed by Damon Wiseley, RRT-CPFT, B.H.S.c.
In one sentence: The RTE exam 2027 is the National Board for Respiratory Care’s (NBRC) new single test that replaces the two-exam pathway — the Therapist Multiple-Choice (TMC) exam plus the Clinical Simulation Examination (CSE) — and your score on it determines whether you earn the CRT or the RRT credential.
If you graduate or test in 2027 or later, this is the exam you’ll take. This guide covers exactly what’s changing, the format and scoring, cost, eligibility, the transition rules for current candidates, and how to study for a test built around clinical judgment.
The RTE at a glance (old vs. new)
| Today (through 2026) | 2027 and beyond | |
|---|---|---|
| Exams required | TMC, then CSE for RRT | One exam — the RTE |
| Exam name | TMC + CSE | Respiratory Therapy Examination (RTE) |
| Total items | TMC: 160 (140 scored); CSE: 22 problems | 185 items (160 scored + 25 unscored pretest) |
| Structure | Knowledge MCQs + branching simulations | One section of breadth questions + one of clinical-judgment questions, all multiple-choice |
| What determines your credential | TMC cut score for CRT/RRT eligibility; pass CSE for RRT | A single exam with two cut scores: low = CRT, high = RRT |
| Time limit | TMC ~3 hr; CSE separate sitting | 4 hours, one sitting |
| Cost | TMC + CSE fees combined | $360 new applicant · $300 repeat |
| Results | CSE results delayed | Same-day preliminary results |
What is the RTE exam?
The Respiratory Therapy Examination is a single, all-multiple-choice credentialing exam that the NBRC will use to award both the CRT and RRT credentials starting January 1, 2027. The decision dates back to the NBRC Board of Trustees’ April 9, 2022 vote, and it continues a long-running effort to streamline credentialing — the same Board removed a second written exam back in 2015.
The exam is built in two parts:
- A breadth-of-knowledge section organized around the same content domains that have always structured the TMC — patient data evaluation, equipment and infection control, and initiation/modification of interventions.
- A depth-of-clinical-judgment section that replaces the old simulations. Instead of branching CSE problems, you answer multiple-choice items built around realistic patient scenarios — varied patient types, in-hospital and out-of-hospital settings, neonatal through adult ages, and the two core clinical activities of gathering information and making decisions.
The big conceptual shift: the clinical reasoning that used to live in the CSE is now woven through the exam as scenario-based MCQs. The skill being tested hasn’t gone away — it’s just delivered differently.
How the RTE is scored: one exam, two cut scores
You take one test and receive one set of results, but there are two passing standards:
- Reach the low cut score and you earn the CRT credential.
- Reach the high cut score and you earn the RRT credential.
This is the change current students most need to internalize. Under the old system, a candidate could earn the CRT and simply avoid the deep clinical-judgment assessment by skipping the CSE. Starting in 2027, every passing candidate — including CRT-level candidates — must answer enough clinical-judgment items correctly to pass overall. The RRT standard, which has anchored the credential since 1961, is being carried forward, so this is not a watered-down exam — it’s a re-packaged one.
RTE exam 2027 format
The RTE administers 185 multiple-choice items: 160 are scored and 25 are unscored pretest items the NBRC is trialing for future exams. Of the scored items, roughly 100 assess breadth of knowledge and about 60 assess depth of clinical judgment, and the entire exam is assembled from independent multiple-choice questions — no branching simulations. You have 4 hours.
What the 2027 blueprint adds, based on the NBRC’s 2024 job-analysis study (6,276 practitioner responses), reflects how respiratory therapy is actually practiced today:
- Ethics woven into clinical scenarios
- Team communication — closed-loop communication, handoffs, debriefings
- Social determinants of health (SDoH) and access barriers
- Newer pharmacology — biologics, CFTR modulators (e.g., elexacaftor/tezacaftor/ivacaftor), and antifibrinolytics such as tranexamic acid
Some lower-yield legacy content — diagnostic percussion is the classic example — is being trimmed. Expect a meaningful share of neonatal and pediatric items and a real presence of out-of-hospital cases.
Where to go deeper: How the 2027 exam tests clinical judgment · Scenario-based MCQs explained · New drugs on the 2027 exam · Ethics on the 2027 exam · Cultural & trauma-informed care
RTE exam cost
The RTE costs $360 for new applicants and $300 for repeat applicants. For candidates pursuing the RRT, the single-exam pathway is less expensive than paying separately for the TMC and the CSE under the old system.
Who is eligible to take the RTE? (Important eligibility change)
To sit for the RTE beginning January 1, 2027, you must hold an associate degree or higher from a CoARC-accredited, advanced-level respiratory therapy program. This matters because the CRT-to-Registry Admission Policy expires at the end of December 2026. That policy previously offered a route to the RRT for some credentialed individuals who did not hold a two-year CoARC advanced degree. Once it’s gone, that alternative route closes. The CRT credential itself is not being eliminated — but the eligibility door for the new exam is narrower.
“Can I still take the CSE?” — the 2027 transition rules
This is the most time-sensitive question for anyone testing around the changeover:
- If you pass the TMC at the high cut score before December 31, 2026, you may still take the CSE through December 31, 2027 to earn your RRT the old way.
- Alternatively, you can take the new RTE on or after January 1, 2027 and pass at the high cut score to earn the RRT.
- If you don’t meet that high-cut-score-by-2026 condition, the RTE is your path.
Deciding between finishing under the old system and switching to the new one is a real strategic choice with trade-offs. Read our full breakdown: Should you take the CSE in 2027 or switch to the RTE?
How to study for the RTE exam
Because the exam now tests how you think, not just what you recall, effective prep looks different:
- Train decision-making, not memorization. Practice choosing the best next action from realistic patient data, then justify why the other options are wrong.
- Over-weight interventions. The “initiate and modify interventions” domain carries the most weight — ventilator changes, oxygenation strategies, and care-plan modifications should be where you spend disproportionate time.
- Drill the information-gathering → decision-making loop. For each scenario, force the two questions: What data do I need next? then What change do I make now?
- Add the new content early. Ethics, closed-loop communication, SDoH barriers, and the newer pharmacology classes are fair game and easy points if you’ve prepared.
- Cover the full age and setting range. Neonatal/pediatric and out-of-hospital scenarios are baked into the blueprint.
Build the right way from day one. Respiratory Cram’s RTE Prep Platform is built specifically for the 2027 format — scenario-based MCQs, full rationales, and a clinical-judgment engine that trains the exact reasoning the new exam rewards. Start preparing for the RTE → respiratorycram.com
Frequently asked questions
When does the RTE exam start?
January 1, 2027. Same-day preliminary results begin immediately.
Does the RTE replace both the TMC and the CSE?
Yes. One exam replaces both. The standalone CSE is retired (with a transition window through December 2027 for qualifying candidates).
Is the RTE harder than the TMC?
The NBRC’s stated intent is to hold the same CRT and RRT standards, not raise or lower them. The format is new, but the bar is designed to be equivalent. The practical difference is that CRT-level candidates can no longer skip a clinical-judgment assessment.
How many questions are on the RTE?
185 total — 160 scored items plus 25 unscored pretest items — in a 4-hour sitting.
How much does the RTE cost?
$360 for new applicants and $300 for repeat applicants.
Can I still take the CSE in 2027?
Only if you passed the TMC at the high cut score before December 31, 2026. Those candidates can take the CSE through December 31, 2027. Otherwise, you take the RTE.
Do I still earn a CRT and an RRT?
Yes. Both credentials continue. A single RTE score with two cut scores decides which one you earn — low cut score for CRT, high cut score for RRT.
Source: National Board for Respiratory Care, “Examination Changes Coming in 2027 — New Details Added,” nbrc.org.
