How to Become a Respiratory Therapist in 2026: CRT to RRT Route
The full route to working as a respiratory therapist, in order: program, NBRC CSE exam, state licence and renewal, with timings and what each step costs you.
- $82,280Median pay
- +9%Job growth
- About 2 years for an associate degree; about 4 years for a bachelor's degreeTraining
- NBRC CSEExam
- $200Exam fee
Table of Contents
The route, start to finish
Becoming a respiratory therapist is a fixed sequence: an approved program, the NBRC CSE exam, then whatever your state requires on top. Here is every stop in order, with realistic timings.
- 1
Complete prerequisites
0-1 yearFinish high school (or equivalent) and the science/math prerequisites your chosen program requires, typically anatomy and physiology, chemistry, microbiology and college math.
- 2
Graduate from a CoARC-accredited program
2 years (associate) to 4 years (bachelor's)Earn at least an associate degree from a CoARC-accredited entry-into-practice respiratory care program, including supervised clinical rotations; this is the only route NBRC will accept for the RT Examination from 2027.
- 3
Pass the TMC at the high cut score (through Dec 31, 2026)
3-hour examPassing the 160-item TMC at the low cut awards CRT; the high cut awards CRT and CSE eligibility. TMC applications close Dec 15, 2026 and the last test day is Dec 31, 2026.
- 4
Pass the CSE (through Dec 31, 2027)
4-hour examCandidates who hit the TMC high cut by Dec 31, 2026 can take the 22-problem, 4-hour CSE until Dec 31, 2027; passing awards the RRT.
- 5
Or: pass the new RT Examination at the high cut (from Jan 1, 2027)
4-hour examGraduates testing in 2027 or later take one 185-item, 4-hour RT Examination; the low cut awards CRT and the high cut awards RRT directly.
- 6
Get your state license
Weeks, varies by state boardEvery state except Alaska requires a license to practice; 10 states (AARC, Aug 2026) require the RRT for new licensure, while most others accept the CRT.
- 7
Maintain the credential
Every 5 yearsNBRC credentials run on a 5-year cycle maintained by CE/assessments, re-examination, or earning a new NBRC credential, plus a $25 annual CMP fee; state license renewal is separate.
Step one: the right program
The program is the one step you cannot shortcut. The exam body checks where you trained before it lets you sit, so an unaccredited course can cost you the whole route.
Accreditation: Commission on Accreditation for Respiratory Care (CoARC)
Typical length: About 2 years for an associate degree; about 4 years for a bachelor's degree
Who is eligible to sit the exam
| Route | What you need |
|---|---|
| CoARC graduate (standard route) | Be 18+, graduate of and hold at least an associate degree from an entry-into-practice respiratory therapy program supported or accredited by CoARC; pass TMC at the high cut score to become eligible for the CSE. |
| CRT + 4 years (CRT-to-Registry) | CRT for at least 4 years plus 62 semester hours of college credit including anatomy and physiology, chemistry, microbiology and mathematics. Eliminated effective December 31, 2026. |
| CRT + 2 years + associate degree | CRT for at least 2 years plus at least an associate degree from an accredited entry-level respiratory care program. Eliminated effective December 31, 2026. |
| CRT + 2 years + non-RT bachelor's | CRT for at least 2 years plus a baccalaureate in another field and 62 semester hours including A&P, chemistry, microbiology and math. Eliminated effective December 31, 2026. |
| Canadian RRT | Hold the Canadian Society of Respiratory Therapists (CSRT) RRT credential (listed in the TMC/CSE admission policies ending 2026/2027). |
| From January 1, 2027 (RT Examination) | Be 18+ and a graduate of at least an associate-degree CoARC-supported/accredited entry-into-practice program; pass the RT Examination at the high cut score to earn RRT. |
The exam itself
This is the checkpoint the whole route builds towards. The essentials:
Questions: 22 (20 scored)
Time: 240 minutes
Where you test: Computer-based at PSI assessment centers (NBRC: 'Monday through Saturday at more than 300 assessment centers across the country'); no remote-proctored option is described in the NBRC Candidate Handbook
Passing standard: RRT requires passing the TMC at the high cut score (which also awards CRT) and then passing the CSE. For the CSE, 'points associated with a candidate's set of responses will be summed across the whole examination to yield one score that will be compared to the cut score'; the cut score is linked to committee decisions about whether each positively scored option is required for minimal competence. NBRC does not publish the numeric cut scores on its exam pages.
Fee: $200
We broke the exam down domain by domain, with the weight of each and what its questions ask, in the NBRC CSE content outline.
Licensure: what your state adds
Respiratory therapists must be licensed in every state except Alaska (BLS), and the NBRC credential is the exam most state boards use. Per the AARC (Aug 2026), 10 states require the RRT for new licensure: Ohio and California (2015), Arizona (2017), Oregon and New Mexico (2018), Georgia (2020), Washington and West Virginia (2022), Missouri (Jan 1, 2027) and Indiana (Jan 1, 2028), each with CRT grandfathering rules. The NBRC credential and the state license are separate and renew separately.
Pay and job outlook
The US Bureau of Labor Statistics files respiratory therapists under “Respiratory Therapists (SOC 29-1126)”. Median means half earn more and half less; pay moves a long way with state, setting and experience, so read this as a benchmark, not an offer.
Keeping the credential
Requirement: Option 1: quarterly assessments and/or CE (15 or 30 CE credits depending on assessment performance, or none if performance is high enough); Option 2: retake and pass the exam for the highest credential held, during the last year of the cycle; Option 3: pass an NBRC credentialing exam not previously completed (resets all credentials to 5 years).
Fee: CMP fee $125 per 5-year term, collected as $25 per year; $250 reinstatement fee if lapsed less than 6 months
The exam is the step most people underprepare for
ExamCert AI has 600 RRT practice questions with explanations, built around the same outline this page walks through. Work them by domain, find the weak area, and fix it before test day.
Practise RRT on ExamCert AINBRC CSE Exam Content Outline 2026FAQ
How long does it take to become a respiratory therapist?
Most people take about 2 years to finish an associate degree from a CoARC-accredited program, then sit the NBRC exams and apply for a state license. A bachelor's program takes about 4 years.
Do I need the RRT to get a license?
It depends on the state. Per the AARC (Aug 2026), 10 states require the RRT for new licensure, including California, Ohio, Arizona, Oregon, Georgia and Washington, with Missouri adding it Jan 1, 2027 and Indiana Jan 1, 2028. Most other states license with the CRT, and Alaska does not license respiratory therapists.
How much do respiratory therapists earn?
The BLS reports a median annual wage of $82,280 for respiratory therapists in May 2025, with hospitals paying a median of $82,730. Employment is projected to grow 9% from 2025 to 2035, with about 8,600 openings a year.
What changes for new graduates in 2027?
The TMC and CSE are replaced by one 185-item, four-hour Respiratory Therapy Examination costing $360 ($300 for repeats). Passing at the low cut awards CRT and passing at the high cut awards RRT, and the CRT-to-Registry experience routes end December 31, 2026.
Sources
Figures on this page come from NBRC and the other primary sources below:
- NBRC - Registered Respiratory Therapist (RRT)
- NBRC - Clinical Simulation Examination (CSE)
- NBRC - CSE Detailed Content Outline (effective January 2020)
- NBRC - Respiratory Therapy Examination Detailed Content Outline (effective January 2027)
- NBRC - Candidate Handbook (Sept 2026)
- NBRC - Examination Changes Coming in 2027
- NBRC - 2025 Examinations in Review
- NBRC - Credential Maintenance Program brochure (Jan 2026)
- AARC - States with RRT Entry to Licensure
- CoARC - Find an Accredited Program
- BLS Occupational Outlook Handbook - Respiratory Therapists
Checked September 25, 2026. Fees, outlines and eligibility rules change — confirm with NBRC before you book.