Respiratory therapist (RRT/CRT) certification & jobs
The NBRC certifies respiratory therapists at 2 levels: CRT for entry and RRT for advanced roles. Here's the exam path, cost, and state licensing.
What's respiratory therapist certification?
Respiratory therapist certification is the national credential the National Board for Respiratory Care (NBRC) grants to clinicians who treat breathing and cardiopulmonary disorders, including asthma, COPD, and ventilator support in intensive care. The NBRC issues 2 credentials on one exam track: the Certified Respiratory Therapist (CRT) is the entry credential, and the Registered Respiratory Therapist (RRT) is the advanced one. Both start the same way, by graduating from a respiratory therapy program accredited by the Commission on Accreditation for Respiratory Care (CoARC) and sitting the same board exam. Which credential you earn depends on your exam score and, for the RRT, a second clinical exam. Nearly every state then requires one of the two before you can practice.
CRT vs RRT: two levels, one exam
The CRT and the RRT come from the same exam, and the difference is how far up the scoring you reach. Every candidate takes the Therapist Multiple-Choice Examination, known as the TMC exam, which has 2 passing marks. Clear the lower cut score and you earn the CRT. Clear the higher cut score and you earn the CRT plus the right to sit the Clinical Simulation Examination (CSE); pass that, and you become an RRT. So the CRT is the entry credential, reachable from the TMC exam alone, and the RRT sits above it, requiring the higher score and the simulation exam.
| CRT (entry) | Earned by passing the TMC exam at the low cut score. It qualifies you for a respiratory care license in every state that regulates the field. |
|---|---|
| RRT (advanced) | Earned by passing the TMC exam at the high cut score, then passing the Clinical Simulation Examination. Many hospitals treat it as their hiring standard. |
Most new graduates now aim straight for the RRT, because many hospitals hire only registered therapists and reserve their staff and charge roles for the credential. The CRT still stands on its own as a license-qualifying credential, and it's the one you hold if you pass the TMC exam at the low cut score but not the high one. When you compare postings, read which of the two an employer actually asks for before you decide how far to test.
Who asks for RRT or CRT
Hospitals are the largest employers that ask for the RRT or CRT, naming it on respiratory therapist roles across the intensive care unit, the emergency department, the neonatal and pediatric ICUs, and the general floors. Beyond the hospital, the credential shows up on jobs at pulmonary and sleep clinics, home care and durable medical equipment companies, skilled nursing facilities, and patient transport teams. In our US listings these are respiratory therapist positions first. Staff and per-diem roles usually list one of the two credentials as required, while some employers hire a credential-eligible new graduate and set a short window to pass the boards.
Requirements and eligibility
- Be at least 18 years old.
- Graduate from a respiratory therapy program with at least an associate degree, accredited or supported by CoARC. This is the core requirement for both the CRT and the RRT.
- No prior credential is needed for the standard route. A new graduate sits the TMC exam directly and doesn't need the CRT first to reach the RRT.
- For the RRT, pass the TMC exam at the high cut score, which then makes you eligible for the Clinical Simulation Examination.
- Alternate RRT routes exist for people who already hold the CRT, built on holding it for a set number of years plus college coursework; check the current terms on nbrc.org. These matter mainly to therapists certified years ago.
- No degree in an unrelated field is required, though some of those alternate RRT routes accept a bachelor's in another subject with set science coursework.
Cost, format, and renewal
The figures below are current as of 2026, from the NBRC. The exam fees are what the board charges; a CoARC-accredited program is a separate and much larger cost the NBRC doesn't set. One change is coming: 2026 is the last year of the TMC-plus-CSE structure, and from January 1, 2027 the NBRC replaces both with a single Respiratory Therapy Examination, so check the current format on nbrc.org before you apply.
| Issuing body | National Board for Respiratory Care (NBRC) |
|---|---|
| Credentials | CRT (entry) and RRT (advanced) |
| TMC exam fee | $190 for a new applicant, $150 to retake (NBRC, 2026) |
| CSE fee (RRT only) | $200 for new and repeat applicants (NBRC, 2026) |
| Format | The TMC exam is 160 multiple-choice items over 3 hours. The Clinical Simulation Examination is 22 patient-management simulations over 4 hours |
| Prerequisite | At least an associate degree from a CoARC-accredited respiratory therapy program |
| Validity period | 5 years |
| Renewal requirement | The Credential Maintenance Program: periodic assessments plus continuing education, or retake your highest credential's exam in the final year of the cycle |
| Renewal fee | A $125 Credential Maintenance Program fee, billed as $25 a year across the 5-year cycle (NBRC, 2026) |
| If it lapses | A $250 reinstatement fee if you renew within 6 months of expiration |
State licensure for respiratory therapists
Forty-nine states regulate respiratory care and require a state license to practice, and the CRT or RRT is the basis for that license in every one of them. Alaska is the exception and doesn't license the profession. The NBRC credential and the state license are 2 separate things: the credential is national and stays with you, while the license is issued by your state board, tied to where you work, and renewed on the state's own schedule and fee. When you move to another state you apply for a new license there, but you carry the same NBRC credential. Because many hospitals now hire only RRTs, many new graduates target the RRT even in states where the CRT alone satisfies the license.
How to get certified
- Finish a respiratory therapy program accredited by CoARC, earning at least an associate degree. Confirm a program's accreditation on coarc.com before you enroll.
- Apply for the TMC exam through the NBRC and pay the exam fee.
- Sit the TMC exam. Pass at the low cut score to earn the CRT, or at the high cut score to earn the CRT and become eligible for the Clinical Simulation Examination.
- For the RRT, apply for and pass the Clinical Simulation Examination, the 22-simulation clinical exam.
- Apply for a license with your state's respiratory care board, submitting your NBRC credential as proof.
- Join the Credential Maintenance Program and track your continuing education so both the credential and the state license stay current.
Demand for RRT or CRT on MedJobList
The RRT or CRT is named in 21 of the active US openings we track right now. Those are respiratory therapist roles at hospitals, health systems, and clinics, where breathing treatment and ventilator management are the daily work. You can browse them in the section below, or filter the full job list by the RRT or CRT credential yourself.
On the job
Keep your NBRC credential and your state license current together, because a lapse in either can pull you off the floor. Employers verify the credential directly with the NBRC, so an expired one shows up fast. Ask at onboarding who pays for the Credential Maintenance Program and continuing education, since many hospitals cover the annual maintenance fee and run in-house CE; it's worth raising in the interview before you pay out of pocket. If you were hired as a new graduate on a conditional basis, know your deadline to pass the boards, because that date is usually firm.
