CSFA Exam Requirements

For first-time candidates, eligibility for NBSTSA's Certified Surgical First Assistant (CSFA) exam is based on graduation from a CAAHEP-accredited surgical first assistant program; approved pre-graduate testing is available. Experience doesn't replace it: being a CST, logging first-assist cases, or holding another surgical assistant credential alone won't qualify you.

Sources: NBSTSA CSFA eligibility; NBSTSA policies, CSFA Eligibility Policy; 2025 CSFA Candidate Handbook, eligibility table, p. 4; CSFA exam application, pre-graduate notice.

By the Castleport Test Prep Editorial Team · Last verified October 17, 2026: NBSTSA eligibility rules, application documents, fees, testing and retake rules, renewal requirements, and the accreditation and state sources cited below.

Not sure which row fits you?

Answer these in order and stop at the first "yes."

1. Are you, or were you ever, an NBSTSA-certified CSFA? You're in the current or former CSFA row.
2. Did you graduate from a CAAHEP-accredited surgical first assistant program? You're in the graduate row. Check the accreditation exceptions below before ruling yourself out.
3. Are you enrolled in that kind of program now? You're in the student row.
4. None of these, including the accreditation exceptions? Your credentials or OR experience alone don't establish a published first-time CSFA route. The section on experience and other credentials explains why and what to do instead.

NBSTSA makes the final eligibility call, and it keeps the processing fee if you apply and turn out to be ineligible (handbook, p. 4). If your case isn't a clean fit, call NBSTSA at 800-707-0057 first.

Check your program's accreditation

Look up the specific surgical assisting program, not just the college. A college can be accredited while one of its programs is not (CAAHEP Student FAQs).

• Use the CAAHEP program finder. It lists programs that are currently accredited and programs holding a Letter of Review. A Letter of Review is not accreditation, so check the status shown, not just whether the program appears.
• Next evaluation date already passed? CAAHEP says that usually means the program is under review, and its accreditation stays in place until the review is finished and voted on.
• Program closed or no longer listed? CAAHEP has a separate verification form for previously accredited and older programs.

ABHES doesn't count here. The CST exam accepts ABHES-accredited surgical technology programs. NBSTSA's CSFA eligibility names only CAAHEP-accredited surgical first assistant programs (eligibility page; application).

What if the program lost its accreditation, or is still seeking it?

NBSTSA's CSFA Eligibility Policy covers both cases. You still have to graduate.

• Accreditation revoked, rescinded, or not renewed: you can still qualify if you were enrolled in or graduated from the program while it held accreditation. Your dates decide it, not the program's status today.
• Program going through accreditation: you qualify if you were actively enrolled when the accreditation site visit happened, and only once accreditation is officially granted. "We've applied" isn't enough.

Experience, other credentials, and the closed 200-case route

CST with years of first-assisting? Not a route anymore. Until late 2016, NBSTSA let current Certified Surgical Technologists (CSTs) qualify through documented first-assist experience. NBSTSA's February 2016 announcement records the cutoff: new applications under the experience pathways were accepted through December 1, 2016, and from January 3, 2017, every new applicant had to be a graduate of a CAAHEP-accredited surgical assisting program (NBSTSA announcement, PDF p. 25 / printed p. 73). The pathways that closed were:

• CSTs documenting case experience
• graduates of non-accredited military programs documenting case experience
• CSA or SA-C holders documenting case experience

Why you may still find the old forms. NBSTSA still hosts the Guide for CSTs with Currency and a Surgical Experience Verification Form. The guide describes facility pre-authorization, malpractice coverage, and 200 cases (75 general surgery, 75 in one specialty, 50 in other specialties). It reads like a live option. It isn't: the current eligibility page, handbook, and application list only accredited-program graduates and current or former CSFAs.

Appeals won't open it back up. NBSTSA's appeals policy says the eligibility requirements themselves can't be appealed. It gives the example directly: it won't accept an appeal from someone who has worked in the first-assistant role but doesn't meet the graduation requirement.

CSA or SA-C. These are separate credentials from other organizations: the CSA from the National Commission for the Certification of Surgical Assistants (NCCSA), the SA-C from the American Board of Surgical Assistants (ABSA). Neither alone gets you into the CSFA exam. A state may accept your existing credential for its national-certification requirement. That does not by itself grant a state license or registration; see the state table below.

Military surgical tech training. NBSTSA's military training route is for the CST, not the CSFA. Base testing overseas is a place to test for people who already qualify, not an eligibility route.

RN, PA, or other licensed clinician. There's no CSFA route for another license. Whether your own license lets you first-assist is a question for your licensing board and facility.

What to do instead. Look for a CAAHEP-accredited surgical assisting program in the CAAHEP finder. Each program sets its own admission requirements, such as whether you must already be a CST, so check with the program (CAAHEP Student FAQs).

What documents do you need?

Accredited-program graduates: send one of these. It has to show your graduation date from the surgical first assistant program and the degree, diploma, or certificate awarded (application; policies).

• A copy of your diploma or certificate of completion.
• An official transcript, sent straight from your school. NBSTSA's policy says official transcripts must come from the issuing institution, so don't count on an unofficial copy you upload yourself.
• A letter on official school letterhead from the program director or registrar, signed and notarized, stating your graduation date and the degree or other completion award received.

Use your official graduation date. For on-campus testing, NBSTSA won't schedule an exam or release results based on a program "completion date" (2026 On-Campus Examination Guide).

Current or former CSFAs: evidence of your NBSTSA certification.

Everyone:

• Apply under your legal name. If it has changed, include a copy of the legal name-change document. Your IDs on test day must match the name on your Authorization to Test.
• Send copies, not originals, of documents like Social Security cards and marriage certificates.
• Need testing accommodations? Send the accommodation request form and supporting documentation with your exam application. Approved accommodations cost nothing extra. The evaluation behind the request should be no more than three years old (handbook, p. 5; accommodation guidelines, p. 3).
• Stationed overseas in the military? You can ask to test through your base education office if the base is more than 100 miles from a test center. Your application must reach NBSTSA at least 45 days before the date you want, and results are mailed within six weeks (handbook, p. 5).

Can you test before graduation?

Yes, through your school or as an approved pre-graduate. Either way, NBSTSA treats the CSFA as a post-graduate certification exam, not a program exit exam, and your result depends on proving graduation on time.

On-campus testing with your class (WBT, web-based testing). Per the 2026 On-Campus Examination Guide, which covers both the CST and the CSFA:

• It's for currently enrolled students, and the whole graduating group tests together. Partial groups test at PSI centers after graduation.
• The exam falls no more than 30 days before or 30 days after official graduation.
• NBSTSA must receive the school's applications, request form, roster, and payment at least 45 days before testing. That's your program's deadline to manage.
• You won't see a pass or fail result until NBSTSA has your graduation proof.
• If you need accommodations, you'll test at a PSI testing center instead of on campus.
• If your graduation might slip, delay testing.

Pre-graduate application at a testing center. The application has a "pre-grad application (not testing on campus)" option. The application doesn't state a separate timing window for it, so confirm your school's arrangement with your program director and NBSTSA before you book.

The 60-day rule covers both. You sign a notice that proof of graduation must reach NBSTSA within 60 days of your actual exam date. Miss it and your result is invalidated and your exam fees are forfeited (application).

Already graduated? Apply as a graduate. Post-graduates testing at a center, usually more than 45 days after graduation, whose required graduation documentation has been submitted may get a score report on test day (handbook, p. 8).

How much does the CSFA exam cost?

Source: 2025 CSFA exam application. AST is the Association of Surgical Technologists. You don't have to be a member to apply; the member rate saves $110 per initial-certification attempt, so compare that with AST's current dues. Rush speeds up NBSTSA's processing of your application. It doesn't guarantee an earlier test appointment.

Before you pay, know what you can't get back:

• The processing fee is nonrefundable, including if NBSTSA finds you ineligible. NBSTSA's two current copies of the form list different amounts: the standalone application says $100, and the copy in the handbook, p. 17 says $60. Either way, it's part of the $240 or $350, not an extra charge. Ask NBSTSA which applies if you may need a refund.
• No refunds once your application is processed and your Authorization to Test is issued.
• Testing through your school? Ask your program director how payment is handled so you don't pay twice. On-campus testing has its own removal and refund rules, which your program director handles.

Recertifying by exam costs more: $450 for AST members, $550 for everyone else (2025 CSFA renewal application).

Your first-time CSFA application checklist

Work through these in order if you're applying for initial certification. Nothing is sent to us.

1. Confirm the credential. You're applying for NBSTSA's CSFA, not the CST, the NCCSA's CSA, or ABSA's SA-C.
2. Match yourself to a route using the table at the top.
3. Verify your program's CAAHEP accreditation in the CAAHEP finder, and keep your enrollment and graduation dates handy if the program's status has changed.
4. Get one accepted graduation document showing your graduation date and award type. Students: confirm who submits the final proof, and by when.
5. Check your legal name against your IDs. Attach a copy of any name-change document.
6. Send any accommodation request with the application, not afterward.
7. Choose your initial-certification fee: $240 (AST member) or $350. Add the $85 rush only if you're a first-time applicant who needs faster processing.
8. Apply online through NBSTSA's practitioner login. Mail-in applications are accepted but may take longer. School-coordinated applicants follow their program director's process.

Open NBSTSA's CSFA application instructions

After approval: ATT, scheduling, and test day

For individual PSI testing-center appointments, once NBSTSA approves you, you get an Authorization to Test (ATT) email with your ATT number and PSI's contact details. PSI runs the testing centers. The following standard rules come from the handbook, pp. 6–8; follow your approved accommodation arrangements where they differ:

• You have six months to test. Go by the expiration date on your ATT. If it runs out, you lose your fees. NBSTSA recommends scheduling as soon as the ATT arrives, even if you plan to test later.
• Schedule with PSI through the link in your ATT or by phone at 1-833-256-1425. The handbook lists sessions Monday through Saturday at 9 a.m. and 1:30 p.m. No walk-ins.
• You can reschedule once for free by calling PSI at least 48 hours ahead, as long as the new date is inside your six-month window. Miss that cutoff and you forfeit the full fee and reapply.
• Bring two current IDs with your current name and signature, at least one with a photo. Driver's licenses, state IDs, passports, military IDs, and green cards work as your main ID. Social Security cards, student IDs, and employee IDs work only as the second one. Both names must match your ATT.
• Arrive on time. Arriving 15 or more minutes late counts as a no-show, and you lose your fees.
• The exam runs 4 hours. You can take breaks whenever you like, but the clock keeps running.
• Scores: for students testing at a PSI center, the handbook describes an emailed score report link within about 48 business hours when PSI has transferred the scores and NBSTSA's file is complete. Graduation proof must be on file before pre-graduate results are released. Campus testers get results after they graduate and the school releases scores.

For on-campus testing, handle appointment changes through your program director and NBSTSA under the school-testing rules. The individual PSI rescheduling rule above does not govern a school request.

If a serious emergency makes you miss the exam, contact NBSTSA within five business days. Your written statement and documentation must arrive within 30 business days after the scheduled exam. NBSTSA accepts six reasons: serious illness (yours or immediate family), a death in your immediate family, a disabling accident, a court appearance or jury duty, an unexpected military call-up, or other extenuating circumstances. Approval isn't automatic, and you may still owe processing fees (handbook, p. 7).

Retakes and appeals

Retakes: you can test up to three times in a calendar year, counting your first attempt. That's three attempts, not three retakes. Each one needs a new application and the full fee, and there's no waiting period before you reapply (handbook, p. 9). You'll still need a new ATT and an open appointment.

Eligibility appeals: if you think NBSTSA wrongly turned down an application that met the requirements, you can mail a written appeal to the Board of Directors with the denial notice and your evidence. It costs $100, nonrefundable, and must arrive within 90 days of the ineligibility notice. The board hears appeals at its spring and fall meetings, and its decision is final (policies).

A pass/fail result isn't appealed that way. The handbook directs a complaint about an adverse pass/fail decision to NBSTSA within 30 days after that decision (handbook, p. 9). The general complaint policy requires a signed written complaint within 30 days of the incident. If your concern is an earlier testing incident, don't wait for a later score report to start that deadline.

The exam you're qualifying for

Sources: NBSTSA CSFA overview for the passing score and time; the CSFA Examination Content Outline, effective January 1, 2023, for the item counts. NBSTSA's overview page calls the third domain "Basic Science"; the outline calls it "Advanced Science." Both list 46 scored items for that domain.

Old rules you may still find online

NBSTSA still hosts older handbooks, forms, and pages, and third-party sites repeat them. If something you're reading disagrees with this page, check its date against this table.

Historical sources: NBSTSA's 2016 eligibility announcement, PDF p. 25; AST/NBSTSA February 2019 update, p. 18; 2019 CSFA Candidate Handbook, p. 9; AST's January 2020 CE policy, p. 5; 2022 AST CSFA FAQ, p. 2, question 8; 2017 AST recertification guide, PDF p. 16. Use these only to identify historical rules. Current requirements and fees come from the 2025 CSFA Candidate Handbook, current exam application, and current renewal application.

Keeping your CSFA after you pass

The CSFA renews every two years. To renew by continuing education, you need 38 continuing education (CE) credits in each cycle, and 8 of them must be live CE (AST's recertification guide, p. 5). Renewal is two steps, with two organizations (NBSTSA renewals):

1. Submit your CE to AST for approval. Credits must be earned inside your current cycle; extras don't roll over. AST charges a $200 processing fee for credits earned while you weren't a member, and that fee includes a year of membership (2024 AST guide, p. 16; current CE reporting form).
2. Renew with NBSTSA through its Learning Builder login and pay $45. NBSTSA recommends getting your CE to AST 60 days before your expiration date.

Running late? If you're 1 to 90 days past expiration and earned all your CE inside the cycle, you can still renew with a $100 late fee, $145 total due to NBSTSA. Your renewal application and fees must reach NBSTSA within that 90-day period. Otherwise you'll need to recertify by exam ($450 AST member / $550 others) (policies, Late Renewal).

Certification vs. permission to work

The CSFA is a national certification. It isn't a license to practice. State rules differ, and the examples below are not a 50-state licensing survey.

Check with your state board and your facility before you take a job.

Quick answers

Can I take the CSFA exam online from home? NBSTSA's handbook describes PSI testing centers, on-campus testing through programs, and base education offices for military members overseas. It doesn't describe a home-proctored option.

Do I need an AST membership? No. Membership lowers the initial-certification exam fee from $350 to $240. AST's nonmember CE processing fee concerns credits earned outside membership dates; joining after earning those credits doesn't remove it (AST guide, p. 16).

Sources

The official requirements, accreditation, and state sources below were checked October 17, 2026.

• NBSTSA CSFA eligibility
• NBSTSA policies: CSFA Eligibility Policy, Appeals Policy, Late Renewal
• 2025 CSFA Candidate Handbook, 1st Edition (V4)
• 2025 CSFA Examination Application
• 2025 CSFA Renewal Application
• 2026 On-Campus Examination Guide
• NBSTSA CSFA application process
• NBSTSA CSFA certification overview
• CSFA Examination Content Outline (effective January 1, 2023)
• Accommodation request form
• NBSTSA renewals and recertification
• AST, A to Z of Continuing Education and Recertification (2024)
• CAAHEP program finder
• CAAHEP Student FAQs
• AST CE reporting form
• Historical rules: the dated publications linked under Old rules you may still find online, plus the closed-route Guide for CSTs with Currency
• State: the controlling statutes, regulations, and board instructions linked in the four-state table

AI tools assisted research and editing. Castleport Test Prep remains responsible for publication under its editorial standards.

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the National Board of Surgical Technology and Surgical Assisting (NBSTSA). Exam and credential names are used to identify their subjects, and trademarks belong to their respective owners. This page explains NBSTSA's published requirements. It isn't an eligibility decision, which only NBSTSA can make, and it isn't a statement about your permission to work in any state.