Surgical technologist certification: CST cost & jobs

What is the CST certification?

The CST is the Certified Surgical Technologist credential, issued by the National Board of Surgical Technology and Surgical Assisting (NBSTSA). It confirms you've graduated an accredited surgical technology program and passed the national exam that qualifies you to prepare operating rooms, set up sterile fields, and pass instruments during surgery. You earn it once by exam, then keep it current on a 2-year cycle with continuing education. Most operating-room employers list the CST as a hiring condition, and in the states that regulate the role it's usually the qualifying standard.

CST vs TS-C vs CSFA

Three credentials get mixed up here, and they aren't interchangeable. The CST and the TS-C both certify the same entry-level surgical technologist job through different bodies, while the CSFA is a more advanced role.

If a job posting just says "surgical tech, certification required", it almost always means the CST or an accepted equivalent like the TS-C.

Who asks for a CST

Hospital operating rooms and surgery centers ask for a CST on most surgical technologist postings. In our US listings the roles that name it are surgical technologists and surgical assistants, posted under titles like scrub tech, OR tech, and surgical technician. The employers are mostly hospital operating rooms and ambulatory surgery centers, where a sterile-field role can't be filled by someone who isn't certified or on track to be. Labor-and-delivery units that staff cesarean sections hire the same credential. A posting that lists "CST or eligible" is aimed at new graduates who've finished an accredited program and are booked to test, so being certification-eligible still gets you into the applicant pool for many of these roles.

Requirements and eligibility

Eligibility runs through an accredited program.

• Accredited program. You must graduate a surgical technology program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES). This is the primary route to the exam.
• Military pathway. Surgical technology training completed in a military program can also establish eligibility.
• No paid experience needed to sit. The supervised surgical cases you need happen inside your program, and the school documents them for you.
• No state license needed to test. State rules are separate from the exam, and they don't gate your eligibility to sit for it. See the state section below.

Cost, format, and renewal

The figures below are current as of 2026, from NBSTSA and AST. The exam covers perioperative care, sterilization and asepsis, instrumentation, and surgical anatomy, and it's scored on the 150 counting questions rather than all 175.

Surgical tech license by state

No state issues a standalone surgical technologist license the way it licenses nurses. Most states leave the requirement to employers, who almost always want a national certification like the CST before they'll put you at a sterile field. A smaller group of states passed laws that require a national certification or a state registration to work, and that list changes as legislatures act. Washington and Colorado, for example, require surgical technologists to register with the state. AST tracks the state laws for the profession, so check your own state before your first job, because where the state requires registration the employer needs both that and the certification.

How to get certified

1. Enroll in a surgical technology program accredited by CAAHEP or ABHES.
2. Finish the classroom coursework and the supervised surgical case requirements your program sets.
3. Join AST before you apply if you want the lower exam fee, then apply to NBSTSA and pay the exam fee ($190 for members, $290 without).
4. Schedule and pass the CST exam at a testing center. The NBSTSA website holds the current candidate handbook and content outline.
5. Register with your state if it requires it, then keep the CST current with 30 CE credits every 2 years, submitted to AST.

The CSFA: surgical first assistant

The CSFA is the Certified Surgical First Assistant credential, also from NBSTSA, and it certifies a different job than the CST. A surgical technologist manages the sterile field and hands instruments. A first assistant works across the field from the surgeon, retracting tissue, controlling bleeding, and helping close. It's a more advanced role with its own training route, so you don't earn it at the same time as the CST.

Eligibility is narrower than the CST's. To sit for the CSFA exam you must graduate a surgical first assistant program accredited by CAAHEP, not the surgical technology program that qualifies you for the CST. Many first assistants start out as CSTs and go back for the additional program before they test.

The exam mirrors the CST's: computer-based, 175 multiple-choice questions with 150 scored, 4 hours, and you pass at 99 correct on the scored items. The application fee matches too, $190 for AST members and $290 for non-members. Renewal is heavier. The cycle is still 2 years, but you owe 38 CE credits with 8 of them earned as Live CE, and the renewal fee to NBSTSA is $45. As with the CST, AST charges a $400 processing fee for CE earned while you aren't a member.

Demand for the CST on MedJobList

The CST is named in 126 of the active US openings we track right now. Those are surgical technologist and surgical assistant jobs in hospital operating rooms and surgery centers, where certification is a standard hiring condition. You can browse them in the section below, or filter the full job list by CST yourself.

On the job

Bring your certification details to onboarding, because operating rooms verify CST status before they add you to the surgical schedule. Ask who pays for recertification: many hospitals cover AST-approved CE and some reimburse the renewal fee, so raise it in the interview instead of assuming. Log your CE credits as you earn them through the 2-year cycle rather than scrambling in the last month before the card expires, and remember that 4 of the 30 have to come from Live CE, which fills up faster than online credit.