NBRC, CRT & RRT: How Respiratory Therapy Credentialing Works- before you can practice as a respiratory therapist, you have to earn a national credential — and the difference between CRT and RRT shapes your whole career. Here’s how the NBRC credentialing system works, and the big change coming in 2027.
Target keyword: CRT vs RRT respiratory therapist • Last verified May 2026 against current NBRC sources
| The short answerRespiratory therapy credentials are awarded by the National Board for Respiratory Care (NBRC), and there are two: the Certified Respiratory Therapist (CRT), the entry-level credential, and the Registered Respiratory Therapist (RRT), the advanced credential most employers now prefer or require. Through December 31, 2026, you earn them via the Therapist Multiple-Choice (TMC) Examination — a low score earns the CRT, a high score earns the CRT plus eligibility for the Clinical Simulation Examination (CSE) that leads to the RRT. Starting January 1, 2027, the NBRC replaces that two-exam system with a single comprehensive Respiratory Therapy Examination whose score alone determines CRT or RRT. To sit for either, you must first graduate from a CoARC-accredited respiratory therapy program — which is where your prerequisites come in. |
If you’re researching a career in respiratory therapy, you’ll quickly run into a tangle of acronyms — NBRC, CoARC, CRT, RRT, TMC, CSE — and it’s not obvious how they fit together. This guide untangles them. It explains who grants RT credentials, the real difference between the CRT and RRT, how the credentialing exams work today, and the significant change arriving in 2027. Understanding the credential pathway matters even at the prerequisite stage, because every step — including the courses you’re completing now — is building toward eligibility to sit for these exams. For the full requirement list that starts the journey, the respiratory therapy prerequisites guide is the hub. Note up front: this guide covers credentialing and the path to it, not clinical practice or patient care.
The first thing to get straight is that two separate national bodies govern the path to becoming a respiratory therapist, and they do different things:
The relationship is sequential: you graduate from a CoARC-accredited program, which qualifies you to take the NBRC exams, which award the credentials that — in nearly every state — qualify you for a license to practice. Three layers: accredited education, national credential, state license. Each depends on the one before it.
| The pathway in one linePrerequisites → CoARC-accredited RT program → NBRC exam(s) → CRT and/or RRT credential → state license. Each step is the gate to the next. Your prerequisites are the very first gate — they qualify you to enter the accredited program that everything else follows from. |
The two NBRC credentials represent two levels of professional achievement, and the distinction matters for licensure, hiring, and advancement.
The Certified Respiratory Therapist (CRT) is the entry-level credential. Earning it demonstrates entry-level competence and, in nearly every U.S. state, qualifies you for the license that lets you legally practice as a respiratory therapist. (One commonly cited exception is Alaska.) The CRT is a fully valid credential to begin a career on.
The Registered Respiratory Therapist (RRT) is the advanced credential. It indicates a higher level of knowledge and clinical judgment, and it’s the credential most hospitals now prefer or require for new respiratory therapists. For career growth — charge roles, intensive care units, specialty practice, leadership, and graduate study — the RRT is increasingly the expectation rather than the bonus.
In practice, the trajectory most students aim for is to earn the RRT, either directly or by earning the CRT first and then completing the additional step to the RRT. Because the CRT can qualify you for a state license, some new graduates begin practicing as a licensed CRT while completing the path to the RRT — earning an income and gaining experience in the interval. Both credentials are real and respected; the RRT simply opens more doors, which is why it’s the target for most people entering the field today.
| CRT (Certified) | RRT (Registered) | |
|---|---|---|
| Level | Entry-level | Advanced |
| Demonstrates | Entry-level competence | Higher knowledge & clinical judgment |
| Licensure | Qualifies for license in nearly all states | Qualifies for license; preferred/required by many employers |
| Career reach | Begin practicing | ICU, specialty, charge/leadership, grad study |
Under the system in place through the end of 2026, both credentials flow from one multiple-choice exam, with a second simulation exam for the RRT:
The Therapist Multiple-Choice (TMC) Examination. This is the gateway exam — 160 multiple-choice items (140 scored plus 20 unscored pretest items) over three hours. It has two cut scores. Achieving the low cut score earns the CRT credential. Achieving the high cut score earns the CRT and makes you eligible for the Clinical Simulation Examination. In other words, everyone takes the same TMC; your score determines which door opens.
The Clinical Simulation Examination (CSE). Candidates who hit the high cut score on the TMC and meet eligibility requirements take the CSE to earn the RRT. The CSE consists of 22 problems (20 scored, 2 pretest) over four hours, presenting simulated patient scenarios that test clinical decision-making. Passing it completes the path to the RRT.
So the current RRT path is two exams: pass the TMC at the high cut score, then pass the CSE. The CRT path is one: pass the TMC at the low cut score. This is the system every current RT student has prepared for — but it’s changing.
| Heads-up: the credentialing exams are changing in 2027If you’ll graduate and test in 2027 or later, you’ll take a different exam than today’s students. Plan around the system that will be in effect when you actually sit for it, and confirm the current details on the NBRC’s site, since this is an active transition. |
The NBRC is replacing the two-exam system with one. Beginning January 1, 2027, a single comprehensive Respiratory Therapy Examination becomes the pathway to both credentials. Your total score on that one exam determines whether you earn the CRT or the RRT — there’s no separate simulation exam to schedule and sit. The new exam folds the clinical-judgment testing that the CSE used to provide into the single exam through applied, scenario-based items.
The NBRC’s stated goal is to simplify the path into the profession — removing the logistical hurdle of scheduling and passing a second exam — while preserving the rigor and meaning of the CRT and RRT standards through a cut-score study that maps the current standards onto the new exam. For students who found the separate simulation exam stressful or hard to schedule, the single-exam model is likely a welcome simplification, though it still tests clinical judgment, now in a multiple-choice format.
There’s a transition window worth knowing if your timing straddles the change. The current TMC and CSE pathway runs through December 31, 2026. Candidates who pass the TMC at the high cut score before the end of 2026 but haven’t completed the CSE get a grace period: the NBRC will continue offering the CSE through December 31, 2027 for them. After January 1, 2027, the new single Respiratory Therapy Examination is the only option for new candidates. The practical takeaway: if you’re testing in 2026, you’re on the TMC/CSE system; if you’re testing in 2027 or later, you’re on the new single exam; and if you’re right on the boundary, check the NBRC’s transition rules carefully.
| Through Dec 31, 2026 | From Jan 1, 2027 | |
|---|---|---|
| Exams | TMC + (CSE for RRT) | One Respiratory Therapy Exam |
| How CRT vs RRT is set | TMC cut scores + CSE | Single total score |
| Simulation exam | Separate (CSE) | Folded into the one exam |
Exam structure is in active transition; always confirm current details on the NBRC’s official site before planning your testing timeline.
Earning a credential isn’t the end — credentials earned on or after July 1, 2002 must be maintained. The NBRC’s Credential Maintenance Program (CMP) requires renewal on a five-year cycle, commonly satisfied by completing 30 hours of continuing education over the five years (or by other routes, such as completing quarterly assessments or passing a credentialing exam). The standard currency for that continuing education is the American Association for Respiratory Care‘s Continuing Respiratory Care Education (AARC-CRCE) program — the NBRC accepts AARC-CRCE credit toward credential maintenance.
In practice, a working respiratory therapist’s state license renewal and NBRC credential maintenance tend to run together: most states require continuing education for license renewal (commonly 20–30 hours per two-year cycle), and satisfying the stricter state requirement generally covers the NBRC’s as well. The detail that matters when choosing courses is AARC-CRCE approval — that’s the credit type state boards and the NBRC recognize. This is a later-career concern, not a prerequisite-stage one, but it’s part of understanding the full credential lifecycle: you earn the credential, then you keep it current through approved continuing education.
Once an RRT, a respiratory therapist can pursue NBRC specialty credentials that recognize advanced expertise in specific areas — for example, credentials in pulmonary function testing, neonatal/pediatric specialty, sleep disorders, and adult critical care. These are optional, advanced steps built on top of the RRT, and they’re a way experienced therapists deepen their expertise and expand their roles. They’re well beyond the prerequisite stage, but they illustrate that the RRT is a foundation for further specialization, not a ceiling — another reason the RRT, rather than stopping at the CRT, is the goal for most who want a long career with room to grow.
It’s worth connecting all of this back to where you likely are right now: completing prerequisites. The entire credentialing system described above sits downstream of one foundational step — getting into and graduating from a CoARC-accredited respiratory therapy program. And getting into that program is what your prerequisites are for.
The prerequisite sciences and general-education courses — anatomy and physiology, microbiology, chemistry, math, medical terminology — are the entry gate. They qualify you to enroll in the accredited program, which qualifies you to sit for the NBRC exam, which awards the credential, which earns your license. Completing those prerequisites well, with strong grades, is the first concrete move in the whole sequence. PrereqCourses delivers them self-paced through Upper Iowa University, accredited by the Higher Learning Commission (HLC), with credit that posts to an official transcript and transfers into your program. For the full picture, start with the respiratory therapy prerequisites guide, and for the admissions process that follows, see how to get into a respiratory therapy program.
| Why this matters at the prerequisite stageThe CRT and RRT credentials are the destination, but the prerequisites are the on-ramp. Every credential downstream depends on first graduating from a CoARC-accredited program — and that depends on completing your prerequisites. Understanding the full pathway helps you see why getting the prerequisites done right, with strong grades, is the highest-leverage early step. |
What’s the difference between a CRT and an RRT?
The CRT (Certified Respiratory Therapist) is the entry-level credential; the RRT (Registered Respiratory Therapist) is the advanced credential most employers now prefer or require. Both are awarded by the NBRC and qualify you for a state license in nearly every state, but the RRT signals higher clinical knowledge and opens more career doors.
Who awards respiratory therapy credentials?
The National Board for Respiratory Care (NBRC) develops the exams and awards the CRT and RRT credentials. A separate body, CoARC, accredits the education programs. You graduate from a CoARC-accredited program, then take the NBRC exam(s) to earn your credential.
How do I earn the RRT?
Through December 31, 2026: pass the Therapist Multiple-Choice (TMC) Examination at the high cut score, then pass the Clinical Simulation Examination (CSE). Starting January 1, 2027: pass the single new Respiratory Therapy Examination at the level required for the RRT — no separate simulation exam.
What is changing with the NBRC exams in 2027?
Starting January 1, 2027, the NBRC replaces the two-exam TMC + CSE system with one comprehensive Respiratory Therapy Examination. A single total score determines whether you earn the CRT or RRT, with clinical-judgment items folded into that one exam. Confirm current details on the NBRC site, as this is an active transition.
Do I need to graduate from an accredited program to take the exams?
Yes. You must graduate from a CoARC-accredited respiratory therapy program to be eligible for the NBRC credentialing exams. That’s why your prerequisites matter — they qualify you to enter the accredited program the whole pathway depends on.
Do respiratory therapists have to renew their credentials?
Yes — credentials earned on or after July 1, 2002 must be maintained through the NBRC’s Credential Maintenance Program, generally via continuing education (commonly 30 hours over a five-year cycle), using AARC-CRCE–approved credit. State license renewal typically runs alongside this.
Respiratory therapy credentials come from the NBRC, the CRT is entry-level and the RRT is advanced, and the exam system is changing in 2027 — but the path always starts with an accredited program your prerequisites get you into.
CoARC accredits programs; the NBRC awards the CRT and RRT. Through 2026, you earn them via the TMC exam (with the CSE for the RRT); from 2027, a single Respiratory Therapy Examination determines both. The RRT is the credential most employers prefer and the foundation for specialty practice. Whichever exam era you fall into, the first gate is the same: complete your prerequisites, get into a CoARC-accredited program, and the credential pathway opens from there.
Start at the beginning of the pathway. Explore the self-paced RT prerequisite courses — A&P, microbiology, chemistry, math, and medical terminology — through HLC-accredited Upper Iowa University, the first step toward your CRT or RRT.
Plan your path into the profession:
Credentialing requirements and exam structures are set by the NBRC and are in active transition for 2027. Licensure rules vary by state. Always confirm current exam, credential-maintenance, and licensure requirements against the NBRC, AARC, and your state licensing board before making decisions. This guide is general information about credentialing only and is not clinical, career, or licensure advice.
